St John Review (1973)

AT RANDOM

by Watkin W. Williams Deputy Commissioner-in-Chief

S of the Association's G

and

rior's Tr ophy Competitions on November 28 we were honoured by the presence of T he ir Ro ya l H ighnesses Prince and Pr incess R ichard of Glouceste r , who witnes ed the team -tests during the afternoon an d met the judge and 'casualtie ' and a large number of helpers and guests. I n a simple and very moving speech, Prince Richard said that thi was very much of a family occasioll, for the G rand Pr ior's T r ophy itse lf was pre ented in his father's name and the presen t ation of the trophy and other awards had fo r a number of year pa t been made by his mother and was to have been made this year by his brother, Prince Will iam. Before the Director-General invited P r ince Richard to present the awards to the men, and P rincess R ichard those to the women, the Chief Commander made two announcements which gave us all very great joy - first, that Pr ince R ichard had kind ly consented to succeed hi brother a Commandant-in -Chief of Ambu lance Corps and D ivisions in the Brigade, and second l y that Princes R ichard had expre ed the wi h to be actively engaged a a member of the Brigade and would be joining us in J an u ary as a vo l untary 'working mem b e r ' o f Headq uarter taff.

Alt hough he did not, amid the conflicting cla i m of many other intere ts and activi ties, find time to erve h is appre n tice hip as an active membe r of the Bri gade as h is brother had done, Pr ince R ichard took an Assoc ia t ion Fir t id Cour e at the age of 17 and ga i ned h is certificate: and having had the privilege of being the ela ecretary and l ay in tructor at that course I can bear witne to the very keen inte re t that he took in h i training If any proof were neede d of hi genu ine desire t o be as fu ll y invo lved as possi b le in t he ac tivit ies of t he Foundu ti on, it m u t ure ly be fo un d in his r ea di ness to ' lend' h is wife to be a me m ber of ou r H eadqua rt e r staff. Bu t tho e who met o r aw or heard him a t the G r and Pr ior's Trophy Competit ions w ill nee d no ll ch proof, for hi genuine l y per ona l intere t an d invo l veme n t in everyth i ng that was going o n was cl ea r for a ll to see.

P ri ncess R icha r d i the ho l der of a F irst Ai d Certificate gaine d in D en m ark. Apart from being a very charming person, she very much 'on the ba ll '. H er first remark on seeing the new ed i tion of (can tinlled all page 11)

THE 1972 Grand Prior's Trophy competitions held in London on November 28 were won by the ICI Winnington Works' team (men) and the Dorset anrJ Bournemouth police women's team. Brigade teams finished 5th (men) and 6th (women). The trophies were presented by Prince and Princess Richard of Gloucester. Prince Richard has been appointed Commandant-in-Chief of the St. John Ambulance Corps an d Divi sions, an appointment previously held by the late Prince William of Gloucester.

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MOUNTAIN RESCUE

by J. D. Ogilvie

IT IS ESTIMAT E D tha t o n w ell o v e r 300 oc c asions every year walk e rs and clim b e rs on the crags and fells of the Lake Distric t suffer mishap - eith e r a cci dent or illness - serious enough t o require help

Sometimes i t is th eir o wn fault ; s ometimes it is due to circumstances outsid e their control. Oft e n they ca n e xtri ca t e themselves, and with the help of their friends make th e i r w a y down Frequently, however , the help of a mountain res cu e t eam is needed.

The Patterdale Mountain Rescue Team has been called out over 95 times during its first seven years The list of cases i t has dealt with cov e rs most types of incident, enough perhaps to a fford a basis for attempting a classific a tion o f mountain mishaps

ACCIDENTS

Climb ers. There is a tendency, on occasion, for clim bers to fall off ro ck faces or ridges , or to make descents o f gulli es more precipitously than th ey intended. In doing so , the y can break bones, sometim es m o re than one , and sometimes including one of the more important ones , such as skull o r spin e Luckily for the team they usually finish up at the bottom of the crag, bu t occasionally t e chnically difficult rock o r ice and snow cl imbing an d str e tch e r lowering is ne ce ssary t o retrieve th e m The team must be prepared fo r such difficult rescues and luckily it i nclud es among its members some very expert and experienced climbers. The other more ordinary mortals in the team are at home on the fells and are sufficiently tr a ined and practised in the techniques of climbing and rope handling to afford support to the experts

Crag rescues are compar a tivel y rar e in our dale, but Dove Crag has produced three major accid e nts In th e first whi ch was distressing to all c oncerned , a stud e nt sustained a severe fracture of the skull and unfortunately died while the team were carrying him to the helicop t er waiting at Hartsop Hall. In the second a climber with a fra c tured spine was safely rescued In the third accident two climbers fell and between them acquired five severe compound fractures and fracture-dislocations. Luckily in this case the rescue was a joint operation between the Patterdale Team and the Ullswater Outward Bound Mountain School Team - our joint supply of inflatable splints, stretchers and c a rriers w as ju s t sufficient! The patients recovered to climb aga in.

n t h e co l at th e Helvellyn end o f Striding E dg e, a nd sustained ch es t inj uri es b y fa lling d o wn the gully t o wa rds Red Tarn Th e t ea m rend e red firs t ai d ; an d t h en ra d ioed t o o ur bas e, when ce the po lice se n t t he r equ est fo r a h e li copte r to t he RAF

While the team c arri e d th e p a ti e nt t o t he

'Hole-in-the-w all' , th e h eli co pt er was o n its way to th e giv e n m ap r efe r ence, where th e team s fl a r es a n d signa ls e nabl e d it to la nd sa fel y. Within 40 min ut e s of he r a di o call from Red Tarn Gull y t he pa tient was being land e d nea r Car lis le Ho spitaL Fellwalkers. Wa lk er s inju r ies t e nd t o be less seve re, but n o t a lw ays so. In th e winter of 1965 , a m an slipp e d a f e w f eet into a gr ass y gull y n ear th e op of Bo ardale Hau s e. H e d ie d ins t an ta n eo u sly from a brok e n n ec k Mu c h less severe injuries, h o w ever , su c h as s pr a in e d a nkl es, pulled mu scl es and cartilage k n ee injuri es, o ften ne cessi ta t e a ca rry down on a str etc h e r. Ev e n s u ch a se date walk as th a t al o ng the La kes id e pa t h ha s o n t wo occas io ns r esult ed in fractur es o f the tibia , and th e vic tim s have been gr a t e ful fo r t h e pr o mpt a rri va l o f the team with i nfl ata bl e s plint s a nd s tr e t c h e r. Eld e rly la di es and ge n t l e m en o n bus tour s seem t o d elig h t in ex p lo ring th e slipp e ry p a th s o f Aira Fo rce, and they ther e by produ ce a regul a r cro p o f sp rains, dislocations and fractur es. Th e t ea m h as even had t o ca rry d o wn from Gri sed al e Tarn one unfortunat e y o ung l a d y wh o dislocated her sh o uld e r whil e lying d ow n to t ake a drink ! Skiers. The app ea ran ce of sn o w o n th e f ell tops bring s o ut o u r sk i-ing fri e nd s in gre a t numb ers Whil e t h e ' r egul a rs' ar e well equipp e d a nd pr ac t ise d the r e see m s to be a tend e n c y fo r th eir res tl ess office-bound neighb ours t o se iz e t he opp o rtunity to borr o w a pair o f skis and rush up to th e fells b e fo r e making sur e that their app a ratu s is proper ly adju s t e d and that th e y a re th e m selve s pr ope rl y trained Th e modern b o ot prot ects th e ir

huddli ng in a she lt e r ed spot un til he l p arr iv es, i nstea d of b lund er ing ai ml ess ly o n , os in g s t re n gth un til th ey co ll apse.

MISSING WALKERS

an kl e a nd th ey s u ccum b to knee injury or fr ac tu re of the sh aft of t h e t i b ia, a very disa bling co ndit ion

Illnesses. Jlln es can over t ake anyone o n t he fe ll s. Y oung l a d s are just as liab le t o d evelop appen di citi when ca m ping ou t o n the fe ll s as when they are tucked up n b ed at h o m e. E ld erly gent le m en, a tt e mpt ing to repeat their yo u thfu l e x p loits, a n d un aware perhaps of the e x t en t o f t h e d isa b i li ies of their in c r eas ing years, are apt to co ll apse with heart attacks Fin ding the bo d ies and carryi n g them dow n are one of the team's sa dd es t t asks. T h e o ldest man the team has h a d to carry down so far was 77. He m a d e a goo d recovery

Dia b etics, w ho, in normal life, keep we ll on t h eir balance d d iet and a n ti-d ia b etic d rugs, do not al ways rea ise t h at th e e x tra outpu t of en ergy expended i n c limbi ng the fe ll s, with perhaps a l apse fro m t heir routine foo d intake can lead to sud d en and dangerous coma. T h is req ui r es ur gent treatment and the t.eam mu st b e prepared to recogni e the co nd itio n and effect. a rapid rescue. It is t o b e h o p e d t ha t diabetics coming to the fe ll s are m a d e aware of the dange rs, and p arti cu la rl y t hat they s h ou ld carry so m e o bvi o u s in d icat ion, suc h as a wri t strap, of th eir con d it ion.

Exposure The cooling effect of ram an d wind , ad d e d to the exhaustion of wa lk ers, ofte n exacerbated by being lost or inj ur e d , can cau e rapid and seriou co ll apse du e to the co nd ition of e xh aust ion -e x posure Many tim es have t he tea m foun d , carried down a nd t r eated e xp os u re c a ses. T h e con d ition is one on wh ic h mu ch research has b een carrie d out in r ecent years, an d the tea m s have t.o wo r k hard to keep up-to-date wi th m e th o d s an d equip m ent. The rapi d t.aking up of t h e insu la t i ng casualty bag, and the co rr ect tr eatme n t o n the fe ll top, are per h aps th e m ost b fe -saving of a ll heir vari e d tas ks. F o r t h is co nd i t io n , pr even ti on is para m o u n t. Wal kers shou d be fu ll y aware of t h e con di t ion ; t hey shou ld ake a d eq uat e foo d ; a n d they shou ld alw ays ha ve with the m rese rves of w i ndproof and w ate r p r oof cl o th i ng Lea d e rs of pa rt ies of yo ung p eo pl e sh o uld b e a d equa t ely tr a in e d. Th ey sh ou ld a t least ho ld th e Mount a in L ea d e r ship Cer t ificate. Th e pa rt y sh o uld ca rr y lar ge heavy gau ge po l y he n e b ags, at leas t 6 fee t b y 3 feet, fo r th e p re li m in a r y ns ul a ti o n of cases, a nd t h ey sh o uld go to gr o u nd, b y

(a ) Temporaril y lo s t. We have a ll bee n guilty of losing our way on the m ou n tains T h is is often due to su d den deterioration of the wea t her and it can happen even with reasonab le use of map and compass. Freque ntl y a wa lker wi ll come d ow n in to th e w rong va ll ey and fi nd himself, as d arkness fa ll s, far fro m his ex pected destination. Anxious relat ives or friend , worrying about t h e de l ayed return , alert the police. Consu tation then takes place between po lice , relatives and the team leaders. The di, fi ; ult decision to decide whether to start a search has to be taken. O u r team see m s to have a happy knack of choosing zero hour, and co ll ecting the t eam together just as the missing person turns up a frustrating time for those of the team who were geared up for exercise and were looking forward to a night on the fe ll s Thi has happened perhaps a sco re of times. The team a lso claims the most rapid successful earch the meeting up wi t h the lost' one just as they passed the Wh ite Li on.

(b ) R e ally mi ss ing Shou ld the immediate search fail to find the missing person a further conference is held, and a routine procedure is adopted. Police investigate likely places such as bus shelters, you th hostel, other valleys and the person's home . (Despite their efforts this cannot be conclusive. Our team spent many hours searching the H art Crag area on one occasion for a b oy who had changed his plans and was all the time in the comfort of his grandmother's home in West Cumber and). A night s e arch is then carried out by the local team and perhaps one or more of their neighbouring teams To search in the dark seem an over-rated pastime, and one not likely to be crowned with uccess, but it mu t be done, in case the victim is lying inju re d on a path b lowing his whistle or fla hing his torch. A dawn search wi ll be started by other teams, and specially trained mountam search dogs may be called in. A meeting is called of the Lake District Search Panel , on which all teams are represented. A control cen t re is set up and with the help of the police, other teams arc ca ll ed in from as far away as La n c a hire, Y orkshire and Nort hu mberland The R AF as we ll as providing a team, may supply a helicopter, a nd th e WR VS doe terling work in feeding the multitudes that converge on Search Con t ro l. O u r team have taken part in such mass searches in Scafe ll (2) Gras m L:re and Langdale. T h ey had their ow n t u rn in Au gust, 1968, wh en a gigantic search wa carr ied out for a yo u th all eged l y missing on I [e lve ll yn.

P a tt er d a l e a n d K eswick searche d thro u ghout the night in very bad weather ;

K enda l took over at d awn . Within 18 hours of the fi rst call, 16 teams with a tota of several hu ndre d trained searchers, a ll unde r radio control from base, were systematically combing the area. Lu ckily for the boy but perhaps rather frustrating for the teams - he was all the time enjoying the comforts of the va ll ey below. The only consolation for our team is that it affor d ed excellent practice and p roved our H Q to be an excellent contro l room!

The other searches the team has taken part in have been ultimate l y more serious After 48 hours one begins to think that one is looking for a bo d y rather than a livin g person, bu t the earch must continue. A n example of this was affor d ed by the search for the missing boy on S cafell this year. Despite his 36 hour alone, over 3,00 0 feet high, in bad weather , he was found compa r atively unharmed.

Oth e r Call s. P arts of the parish are 35 m ile from a hospital casualty department and 15 mile from an ambulance. R oa d accidents, sometimes fata l are fairly frequent, particularly during the holi d ay season A major b us accident with m Ultip le casualties occurre d on the K i r ks tone P ass sh ort ly before the for m ation of the team. Their stock of equipment - Tho m as splints, inflatab le plints, ca ualty bag, etc., although pri m arily intended for u e on the mountain i of course availab le and has frequent ly been u ed for road accidents.

On three occasions our Land- R over ambu lance has been used to convey patien t s over rough grou n d to the c o u nty ambulances waiting on the hard road. On ce when G lenri d din g wa iso lated by drifted snow, a eriously ill G enridding boy was ab le to get to

P enrith, after a rather haza rd ous journey in our vehicle. O n anothe r occasion a local farmer, m issin g i n his f ie ld s after da r k havin g ha d a ser ious stroke, was brou ght in by our st re t cher and am b ulance.

Sai ling, b oatin g and bathin g casualties occur on ou r lake every year. A lthough the tea m does no t claim to b e instantly transportable by water, as is its nei ghbour the Ullswater OB MS , the res u sci t ation appa ratus and the knowle dg e how to use it coul d be invaluab le. Sheep [n earch of mo re succu lent supplies of grass, sheep so m etimes descend crags, le d ge b y led ge, until they find themselves sufferin g the in dig nity of bein g cra g fast. There they stay unti l they die of starvation or fall off. Mo untam rescue teams are calle d in by the fa r mers to effect rescue. More than eleven ti m es, the P atte rda le tea m has been the rescuers S o far, as least as far as sh eep are concerned, they haven't lost a patient. D o they do it for humanitari an reasons; to keep on the right side of the far m e rs; or for practice on 'grotty' cra gs? Pe rhap all three.

Mountain Trial s. Sp onsored walk, mo u n t ain tria l , and orienteeri ng race are re gu la r ly he l d on the Lake District fe ll s. It essentia l that the check point for these , often on obscure peaks, should be manned by per onnel who are expert in mountain rescue and radiocommunication. R e cue team volunteer for this work. Patterdale has m anned the s u mmits of Little St and, Gl ara m ara, H artsop Do dd a n d H igh St reet for the e event. It ha affor d e d excellent e x pe rience in ra d io contro l. and it ha been justified in that, on two occa ion, they have had to treat and carry down participants. ( tum page) 5

Patterda!e's Mountain Res c ue team on a quiet day in the h lls

THE TEAM

The p opular idea of a mountain rescue team - a band of expert professional climbers standing by awaiting calls - is a misconception. Each team is different. In our case, with a total population of only 500, one could not expect to find such a group instantly available day and night. Our team consists of local people, of va rio u soc cup a t ion s, bu t all experienced on the fells. Members have included a schoolmaster, parson, farmer, shepherd, lawyer, estate-manager, YHA warden, doctor , postman, shopkeeper, motor mechanic and bus driver. Even those who cannot run up the fells are found a job at base as telephonist or radio operator. We are flattered by the fact that as our personnel move away they insist on staying on as mem bers even though a call-ou t entails consi derable travelling. The experts teach the others. Week ly maintenance meetings are held and regular practices indoors and out. Most members have taken full co urses of first-aid and hold the necessary c er tifica t es. N a viga ti 0 n, c limbing

ORDER INVESTITURE

HELD ON NOVEMBER 161972

AS ASSOCIATE DAME

Mary Lee, Mrs. Douglas Fairbanks (American So ciety)

AS COMMANDER (BROTHER)

Eric Oates Halliwell, FRCP, MRCS (E.R. Yorks)

Ted Broughton (W.R. Yorks)

Surg. R/Adml. Anthony O'Connor, MVO, QHP, FFARCS (Royal Navy)

A/Cmde. Charles Rob ert Griffin, MB, ChB, FRCS (Royal Air F orce)

Ivor Howard Fox (Birmingham)

Charles Edward Jessop, TD (Gloucs)

William Oliver Kirkwo od, MBE, JP (Durham)

Surg Capt. George Augustus Binns, QHS, MRCS , LRCP (Royal Navy)

Maj. Syd ney Joseph Harvey, OBE (Staffs)

Kenneth James Johnson, OBE (Kent)

AS ASSOCIATE COMMANDER (BROTHER) Capt. Raymond Parks (London)

AS OFFICER (BROTHER)

John Charles Coates (W.R. Yorks)

Edgar Herbert (Cornwall)

James Howard Lievesley (Derbys)

Charles Arthur Towle (Notts)

Kenn eth Henry Bottamley (E.R. Yorks)

William Hotchkis Ri chmond Water s, MB, ChB (W.R. Yorks)

Gordon Nanney Barclay Duncan (Lancs)

Vinc ent Arthur Lloyd, MB , ChB, MRCS, LRCP DPL (Birmingham)

John Clement Neal (London)

Edward Fr ederick Somers (Bucks)

Dani e Stachan, OBE (Scotland)

Joseph Bird (Essex)

He cto r Rob ert Ferguson Macdonald, MD, MB, ChB, FRCP (Scotland)

Alec Frank Harden, MB, FRCS (London)

John Bealby Eastwood (Notts)

Bertram Ernest Billington (North ants)

Thoma s Arthur Richards, MB, BS, MD, MRCP, MRCOG (Northants)

AS OFFICER (SISTER)

Gwendoline Ruth, Mrs. Morrish (DfVon)

6

Rachel Mary, Mrs Wenley (Essex)

Winifred, Mrs. Jefferies (Norfolk)

Eve, Miss Bastable (Sussex)

Ruth, Miss Carter, RRC (Royal Navy)

Elizabeth Jocelyn, Mrs St atham (Sussex)

Rosemary Eva, Miss Bailey, MTD, RNT , DN (London)

AS SERVING BROTHER

Albert Victor Down (London Transport)

Frederick Arthur Dunning (Devon)

William Henry Easter (British Rail)

Lt. Col. Geoffrey Fernyhough, TD (London Ambulan ce Centre)

Leslie Arthur Freeman (Birmingham)

James Green (Berkshire)

Cyril Dougla s Gotobed (British Rail)

Clifford Haigh (Cheshire)

Cecil Thomas Hitchcock (Devon)

Harold Sydney Arthur Hillier (Nat. Gas Council)

Leonard Thomas Holman (Post Office)

Henry Cornelius George IIott (British Rail)

Edward Bavington Jones (Lancashire)

Sidney Alfred Jack son (British Rail)

Arthur John Kemp so n , BEM (London Transport)

Thoma s Jame s Kennedy (Birmingham)

William James Knight ( at. Dock Labour Board)

Kenneth William Lancaster (Cheshire)

Thomas Tanner Carr McKenzie (British Rail)

Bernard Edward Roberts (Staffs)

Kenneth James Rod en (British Rail)

Ellis Edwin Jame s Stinton (Birmingham)

Frederick John Ru sh (British Rail )

Percy William Jenn er (Kent)

Cyril Thoma s Ru shton (British Rail)

Arthur Geoffr ey Hick, MB, ChB, MD, DPH, LMSSA (Cheshire)

Frederick John Well s (British Rail )

Walter Rose (Warwicks)

The Revd. Jeffrey Frank Bloomfield (London)

Vincent Geeves (Derby s)

Robert Hope (Durham)

Captain William Kenyon Jew ell (London)

The Revd Richard Henry McPhail Third (London)

rope-craft, signal ling radio

com m u n i c a ti 0 n I i g h tin g new techniques for a ll of these have to be learnt and kept constantly practised.

All of the team members are unpaid volunteers. So far, no member , going to a rescue, search or practice , has been reimbursed [or travelUng expenses, loss of wages or for the wear and tear of his own climbing gear and clothing. Hardl y a rescue goes by without the participants being the poorer for broken flasks, l ost torches, torn anoraks, lost wages or postponed business appointments.

John Warwick Prou t, MRCS, LPCP, DIII (Kent)

Ernest Perr en (Cornwall)

The Revd. Arthur William Newall (London)

William Henry Hales (Derbys)

Warrant Officer Alan Charles Dunn (Royal Air Force)

James Ronald Painter, BEM (Berks)

Alec Ernest Webb (Bristol)

Anthony Hubert Harry Cale (G loucs)

James Herbert Davenport, BEM (Hants)

Pet er Lewi Wood (Ken t)

Henry Ted Forward (Berks)

William George Down (Bristol)

Keith Milne, MB, alB (Cambs)

Alfred Bushell (Isl e of Wight)

Franci Dowton Richard Twiggs (Gloucs)

John Perry, AMBIM (Cheshire)

Wilfred Todd (Birmingham)

Jack Lyons (Che hire)

Eric John Curnow (Cornwall)

Eric Foster (Cumb.)

Leonard Clarke (Derby)

Russell Wale Fairhead, MB, BChir (Devon)

Arthur Hudson (Dorset)

Septimus Kirkup (Durham)

George Albert James (G lous)

Albert Frederick Arthur (llants)

Pet er Percival Richard Malone (Isle of Wight)

Raymond Albert Sydney Smith (Bucks)

AS SERVING SISTER

Margaret, Mrs Watson (Northd)

Elizabeth Jane, Mrs. Lovett (Bed)

Margaret Elizabeth, Mi ss Gray (Durham)

lvy Clarice, Mrs. Bartram (Beds)

Clarice Kate , Mrs. Rumble (Bu cks)

Gladys Annie, Mis Brooker (Berks)

Moira Ghislaine Eileen, Mrs. Marriott (Berks)

Mary Caroline , Mrs. Bell, MB, BCh, BAO (Derby)

Myrtle Frances Georgina, Mrs. Bartholomew (Devon)

Annie May, Mr Swabey, SEN (Dorset)

Margaret Grant, Miss Graham (Durham)

Margaret Edith, Mrs. Egg leton (G loucs)

Mary, Mrs. Dandy (Beds)

Winifred Netta Miss Morton (Birmingham)

Ada, Miss Jackman (Bu c ks)

Minnie Evelyn, Mrs Walton (Cheshire)

Vera Maud, Mrs. Prowse (Cornwall)

Esme Mary, Mr O'Donnel (Derbys)

Barbara Maureen, Mrs. Joys, SRN (Devon)

Anne Fraser, Mrs. Earle, MA (Dorset)

Rita Helen, Mrs. Turner (Durham)

Greta, Mrs. Sanderson (Durham)

Ellen Patricia, Mrs. Somers (Bucks)

AS ESQUIRE

The Viscoun t Furness, Knight of ] llstice, introduced to the Lord Prior his per onal Esquire, Rodney David Carew-Jones.

First Presidents' Conference

THE FlRST District and County Presidents' conference, held at headquarters on Novem ber 7, was attended by Margaret in her new role as Grand Pr esident of SJ A, and chalred by Lady Brecknock, Chief President. 43 delegates from throughout the country attended the conference.

Subjects discussed included the role of the preSIdent fund raising, and welfare.

Princess Margaret, with Lady

Ex-chairman of S J Council for West Malaysia invested

AT A ceremony on ovember 22 at SJA headquarters the Lord Pr ior, Lo rd Caccia, invested Tan Sri Haji Sardon Bin Haji Jubir, recently appointed Minister of Communications, Federation of Malaysia, as a Commander (Brother) (Associate) of the Order of St. J oh n. I'"

Tan Sri Haji Sardon's wIfe has been the Principal Superintendent (Nursing) for West Malaysia for many years , and became a Commander (Sister) of the Order in 1966

(Right)

Brecknock, and Isle of Wight County President, Earl Mountbatten of Burma. (Below) The conference in progress

PRINCE RICHARD

His R oyal Highnes Prince Ri chard of Gloucester has accepted the appointment of Commandant-in-Chief of St. J ohn Am b u 1an c e Cor p s a 11 d Divisions previously held by the late Prince of Gloucester.

This means that Prince Richard will be the overall head of some 123,000 Brigade male members in this country and throughout the world

Prince Ri chard's interest in St. J olm started in his days at Eton, when he took a SJ A first aid course. The Princ e, who a lso has a keen interest in St. John work is to play an active role at Headquart ers: beginning in the New Year.

LIFE SAVERS

A road accident victim was brought back from the dead three times by two women on their way back from a Brigade meeting at Coseley , near Wolverhampt on, recently.

The incident happened at traffi c lights only yards from the Coseley St. John headq uarters.

Mrs. Maxi Paskin and Miss Sandra Draper, together with their superintendent , Mrs Joan Barwell had just left their weekly divisional when they saw the accident scene. They rushed to the victim's aid and applie d their invaluable experience.

'Maxi and Sandra gave the injured man the kiss of life and cardiac massage He was very ill. In fact his heart stopped on three occasions but each time they m anaged to bring him back to life', said Mrs. Bar well

The man was rushed to hospital, with head, leg and facial injuries

Th e three SJA members, who on l y

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST. JOHN

BY THE EDITOR

APPOINTMENTS

Montserrat: Area Commissioner (post recently upgraded from Area Supt.) : Mr. Galton, St. John , Police Headquarters, Plym outh.

Sec retary/T re asurer: Mrs. Fran Hawes

Jamai ca: Chairman of Council : Mr. L. R Read, MM, FCA.

Se cretary: Miss M. Stephens, MBE.

happened to still be at their headquarters because 'they stayed behind for a chat' accompanied the injured man to the

hospita 1.

THE COST

lnd u try, which htl a statutory o bligation to provide first-aiders on premi es with over 50 workers, mu t in future be prepared to puy the full cost of first aid training course and not expect them to be subsidised from charitable funds.

This was the mes age that emerged from a weekend conference held lat e October for cadet and adult members of the St. John A mbulance in Peterborouoh and orthampton Over 100 attended the con ference.

Deputy Commissioner-in-Chief, Mr Watkin W. Williams from the Brigade headquarters in London, said that as Brigade members they had, rightly so, a tradition of giving their servIces free on Brigade duties, but a far as first aid training for the public and industry was concerned, they had a commodity for sale.

If indu try could spend money on management trainees it could do so for first aid workers.

Deputy Commi sioner for orthamptonshire, Mr. B. Billington, said first aid cia ses hould ideally be around 20 to 25 and not, as was usually the case, around 70. It was impossible to teach first aid satisfactorily to such large cIa es but very often it wus done to keep the costs down

'These cour e should not be subsidised; we should not subsidise the [1U b lic, he aid. 'To make these co urses pay there must be higher charge. Industrial course mu t certain ly pay for themse l ves clI1 d not be subsidised by charitable funds.'

Mr. Billington introduced N orthamptonshire 's Chief Ambulance Offi ce r, Mr. P. Wilkin on, who has just been appointed County Director of the St. John Ambulan ce Association in Northam ptonshire.

Mr. Wilkinson told the conference that when he took over in 1948 the task of forming tbe ambulance service he was helped by many of his friends in St. John. Only with their help had he got the service to the standard it had reached today. He had therefore come back to return some service to the S1. John. He had several aims as County Dire ctor in Northamptonshire which had industry pouring into it. 'We and the Red Cross have accepted the task from the Government of training industry and thIS we must do.'

He said the largest problem was finding lay instructors and administrators from the Brigade for full-time work in training - there was nowhere e lse he could find such people. His second target was in the field of education. The school leaving age had

IT'S FUN

Ford (left) take a break during a recent conference. See THE COST

been advanced to 16 giving teachers an extra 12 months to fill in. 'We shou ld get in here and teach first aid so that everyone knows first aid at the age of 16 .'

MED. CONF. 73

I hear that arrangements for the 1973 SJ A Medical Conference are well in hand; and the chairman of the conference working party, Dr. 1. C Graham, hopes it will be as good, if not better, then last year s. It will be held at Nottingham University, from March 30 to April 1, inclusive. At the moment it looks as though the Ro yal Air Force will be arranging a symposium for the Saturday morning, which will include some extremely interesting exhibitions and displays. The Saturday afternoon will be taken up by the Birmingham Accident and Rehabilitati on Centre, under the direction of Mr. P. London, MBE, MB, MCh, FRCS, LRCP Mr. London has

(Below) 'Amie', as Ealing SJ call their resuscitation model, gets a lift by cadets to a recent exhibition. (Right) While at Cheltenham, SJ 'Bunnies' Gillian Ri cketts and Teresa Seabourne helped the autumn fair to produce £1,066 profit ( Pho to: Cheltenham Newspapers)

arranged a very interesting symposium which will prove of great value to all delegates.

The programme for the Sunday is not yet completed, Application forms for the conference will be available about February 1973, but reservations for places may be addressed to the Medical Secretary at Headquarters, now.

TO RESERVE

Mr. Henry Loveday Bosworth, OBE, K S t J ,of F a rn s fie 1d , otts, has relinquished his post as SJA Commander, ottinghamshire, after 39 years continuous service in the Brigade He has transferred to the Reserve , but continues chairman of the joint county committee of St. John and Red Cross and a member of the St. John Council for ottinghamshire.

BLACK OUT

Cadet Jennifer Parker, 13, of Grays, Essex, who contributed a story on a visit to the dentist to this column just over a year ago, tells us about another more pleasant experience, although I for one

fortunately Staffordshire's Miss Sandra Drapper, Mrs Joan Barwell, Mrs. Maxi Pasking See LI FE SAVE RS ( Ph oto: Wolverhampton Chronicle)

Deputy C ommiSSio n · er - n Ch ief Watk n Williams and North· amptonshire's S J Commander J.

can't altogether agree with her final five

wor d s. Bud ding writer J enny, b y the w ay, r ecently had a poem published in the magazine E s sex Countryside, which

w e' ll b e printing. Here' s BL ACK OUT: I climbed onto the chair and looked out of the window. 'It's more than half full,' I said excitedly. ' ot long to go n ow.'

D on't lean so far over on the chair?'

warne d Val, adding 'It ooks as - .' The

c h air wo b b l e d , and I topp l ed to the floor. Well , I warned you T hanks for the sympathy.' I grinned.

T h at was a great start to the evening ou r annual enrolment. Our division

a lways has its enro l ment ceremony with t he boy cadets T h ere were so many of us

we ha d hired a school hall, where there was p enty of space and several rooms,

o n e of w hich we were in now.

I h a d arrived at half-past-four that

a f ternoon We ha d all brought our tea

w ith us so that we could have a last

minute rehearsal of the entertainment we had planned. ow all the parents were arriving

While we waited we sat talking and made sure we were looking respectable. We seemed to wait for hours, when the door opened and our Divisional Officer came in. She told us to line up, and then we marched out. The boys were already on parade and I saw my cheeky young brother grinning all over his face from the middle rank.

We were brought to attention as the area officers and guests came in. After a short peech of welcome to the parents , we were inspected. It takes a long time to inspect about fifty boys and girls and I wished we could sit down.

At last that was finished and all the juniors to be enrolled lit their candle.

Seniors were enrolled speeches and presentations were made. Then everybody stood up to say the Code of Chivalry - and the lights went out.

We knew that power cut weT : supposed to be coming but w e hadn expected it 0 early. For a minute or t\\ we were in a state of confu ion. We couldn't do our entertainment now.

Then someone lit the candle that th , juniors had u ed and di tributed then throughout the hall. A few people we t to fetch torches from their cars. A bicy d lamp or two was al 0 brought in.

We were wondering what to do, whe r one boy suggested we have a mg- ong Several of the boys had brought the i guitars with them. So we all at down 0: the hall floor. A few candles, meant t represent a camp fire, flickered in 01: midst. One of the gui tari t tarted a on and we all joined in

By the time we'd finished that son, and started another nearly everyone w. singing. Anyone passing by and lookIng 1. to the hall would probably not hay believed their eyes. They would have ee l a very dimly lit hall with guitar mll II coming from a dark patch on the floo r Also loud singing, which apparently cam, out of the walls (for it was so dark rOlln c the side of the hall that no one could be seen).

We were halfway through 'Johr Brown's B c dy' when the lights came or again. We all blinked, our eye unaccustomed to the sudden light. Aftestanding up and stretching a little ( fo' one was very stiff having sat for so long we returned to our room. Refre hmenl. were served as if nothing had happened Unfortunately it was too late to do the entertainment. The lights remained on, S we all proceeded to clear up. Even thougt things hadn't gone quite the way We planned, everyone said they had enjoyec the evening and L thought It had made ar exciting change. I doubt if anything lik e that will happen next year, but rathe hope it does.

IAT RANDOM

(continued from page 1)

the joint manual was '1 thought Holger- ielsen was out' , and she was told 'Yes, it was ; but it s come in again', One of her first commitments on joining Headquarters staff will be to take an intensive day-release course of First Aid for industry. We are immensely looking forward to her joining us and offer her the warmest welcome.

Vertigo

One of my many routine duties is to sign a number of Officers Warrants on behall of the Commissioner-in-Chief. I always look carefully at the details on these, and if they appear to be Warrants of first appointment I note the interval between the date on which Acting Rank was granted and that on which it became substantive. If the interval is considerably more than the six months required by Brigade Regulations for training of Officers on first appointment (and I'm afraid that some of them show an interval of well over a year) , I sometimes send back a note to ask the reason why. This training of a new Officer should whenever possible start before a recommendation is put forward on BF.7 (see first paragraph of BR .3 l); and when once Acting Rank has been granted, every effort should be made by all concerned to complete the training within six months from then.

On the other side of the picture I sometimes get Warrants which appear to be on first promotion, but where the interval is much less than six months - sometimes only a few weeks or even days. I always check these, and usually find that they are transfers of, for example, a Divisional Officer from one division to another. Re cent ly queried two such and was told, to my great delight, that they were Divisional Superintendents who for personal reasons were unable to co ntinue in that appointment and had reverted to the rank of Divisional Offi cer I say to my great delight', because here were two people who realised that Brigade rank is not a series of rungs on a ladder that we have to climb, but merely an indication of the job that we happen to be available to do at any given time, and to revert to a lower rank tor even to mbulance or Nur ing lember) is a realistic acceptance of the job that we are available to do in the Brigade for the service of mankind, and doesn't involve any 'loss of face'. Indeed, those who are prepared to accept such a 'sideways step on the horizontal ladder', far from suffering any loss of face. gain greatly in stature and in the estimation of their fellows.

The other day I met someone who for a number of years had been a County Surgeon and was now a Divisional Surgeon. He said he thought that everyone who had had a good innings in a higher appointment should (if hi age and availability permitted) let omeone else take over and revert to working at 'grass-roots'. It was a most refreshing and welcome point of view, and 0 different from two types of request that (both while working in a county and at IIeadquarters) I have received from time to time. The first of these is when someone moving to a different locality asks for an appointment appropriate to an Officer of Grade so-and-so' as if it mattered what grad you held or how many pips or crowns you had previollsly worn on your shoulder, provided there was a useful job you could do for the ervice of humanity. And the second is when a person is asked to carry out a particular function as part of his Brigade dutie and says that he could not do so in his present rank because it would involve his organising or giving training to people enior in rank to himself. Clearly, there must in any organisation be a proper chain of command, and if members of the chain are distinguished by 'ranks', then their grading mllst be logi ca l. But if go on a training course I'm prepared to receive instruction in some specific subject from anyone who happens to be an expert in that subject, no matter what grade of Officer he may be or even whether he's an NCO or Ambulance Member. And the same principle applies to countless other administrative duties.

Years ago, when I first became involved in Brigade leadership training, my Brigade rank was that of Divisional Superintendent, and I was roped in as a member of a county team to help with courses on which there were sometimes trainees of higher rank than myself. It never occurred to me that this was odd, nor did 1 detect any sense of resentment on their part. Conversely, when a Grade II Officer in the Brigade, I worked for several years as a voluntary Ambulance Attendant with my County Ambulance Service , and while working in that capacity I never for one moment expected to be treated as a 'higher grade' attendant than Ambulance or ursing Members who happened to be doing the same job. Maybe this will horrify some of my readers; but if it does, I would beg them to keep in sight the ultimate object of our Brigade membership to help fellow human beings in distressand maybe that will save them from the vertigo from which they might have suffered by placing the 'ladder of promotion' in too vertical a position!

Nice Club

As Chairman of the St. John House Club, was thrilled to receive recently a cheque for £100 as an anonymous gift towards the renovation of chairs and redecoration of the club dining-room. In a co vering letter the donor wrote: 1 do realize how heavy the club expenses are and I think all we old St. John members are most grateful for having such a nice club and the chance it gives us for often meeting old Brigade friends. My 31 years in St. John were very happy years and but for ill-health I would have loved to be with them still. I often feel homesick when I see the uniformed Brigade members on duty!' May I. on behalf of us all, say a most sincere thank you to this kind and generous friend, whose gift will help to make the club even more enjoyable to its members both young and old, in the not far distant future.

Hugh Stephenson , GBE, KCMG , CIE, cva

AT THE MEMORIAL SERVICE of the late Director General held at St. Paul's Cathedral on November 8, the Lord Prior, L ord Caccia, spoke of Sir Hugh s days in the Indian Civil Service when Foreign Secretary Ernest Bevin said of him: 'If you were ever in a tight corner, you could not do better than have him by you. He would have all the right instincts and know in the marrow of his bones what to do'.

Later in the Diplomatic Corps , Sir Hugh served as ambassador to Vietnam, and also to the Republic of South Africa. 'Hugh Stephenson'. said Malcom 1acDonaid at the time, ' looks hotter and keeps cooler than any of u '.

After retirement, in 1970 Sir Hugh became the Director General of the Association, with its country-wide responsibility for the teaching and examination in first aid. Under his direction the Association went from strength to strength, and he was delighted when he wa able to report the presence of a Director in each county. The number of Association centres doubled during hi term of office and he lived to see ind ustrial training in first aid arried on in 23 counties. With his knowledge of publishing, he took pride in the fact that during his time more First Aid Manual and text books were issued or revised than in any comparable period in the history of the ssociation.

He loved his work' went on Lord Caccia, 'and he fought to the bitter end against ill health to keep going.'

Sir Hugh Stephenson died on September 23 1972.

Sir

The Old World

Part two: Cyprus and the Lebanon

THE 1972 SJA TOUR TO RHODES, CYPRUS, BEIRUT AND DAMASCUS

by Joyce Hamilton

THE ASPELIA HOTEL at Famagusta, where our St John party stayed in Cyprus, is beautifully equipped and situated on the sands of a small bay, which was alive 'wi th gay little boats when we were there. Famagusta is the most fabled city of all Cyprus, fo r within its walls are the citadel and Othello s tower where in Shakespeare's tragedy the Moo; murders his beautiful Desdemona.

On our first day we went to Bellapais a village on the edge of a spur of the Kyrenian mountains. We rested at the Tree of Idl eness, drinking fresh l emon juice, and wat ched a walking haystack pass by - for only the nose and hoofs could be seen of the poor donkey bene ath it.

The abbey of Bellapais, of Gothi c ar chitecture which is a rarity in Cyprus, is surrounded by lovely trees and sh rubs , and overlooks the blue Caramanian Se a. Its refectory, which , amazingly, is intact, has spacious vaulting supported by clusters of slender columns. The windows frame the beautiful views of the plain below , and swallows build their nests in the high roofs. The cloister, with perfect lawns and scarlet geraniums tumbling over ancient walls, is beautiful. Orange trees also grow here in abundance, and dark green laurel bushes, the leaves of which are used for making incense.

The Anglo-Norman builders called the abbey Cloiture de la Paix - Convent of Pea c e. The custodian, a c harming Cypriot, proudly showed us his garden in front of the ticket office. It was brilliant with scarlet and yellow snapdragons, elegant hollyhocks, zinnias, carnations and roses. He said some seedlings, growing high and strong in an old pot, had taken on ly 48 hours to germinate. Gently cupping a rose in his hand, he went on: 'This rose is called Pe ace. I sent to Nottingham for it.

On our secon d day, after a festive lun ch at Kyr enia, we continued our journey to the romantic castle of St. Hil arion. As we climbed the rough track

family the throne of Cyprus remained for three centuries. They rebuilt the castle in the then new Norman style. Sadly , after the Genoese invasion, it was all owed to deteriorat e, its proud walls invaded by thieves and rats and the masonry pillaged for building sto n e. It was only in 1904 that the entrance was closed by the present iron ga tes and the gaps in the walls filled in to prevent further depredations . At the kind invitation of the P resident and officers of St John Ambulance in Cyprus we visited the monastery of St. Barnabas.

to the castle, we remembered the spring flowers we saw here last year; tall golden fennel, five feet high; carpets of cyclamen and shocking pink convolvulus, and lovely rock roses in abundance; blood red poppies and yellow mustard seed ; cow parsley and swaying grasses. Now an occasional lavatera or orleanda shrub grew sparsely a nd the flat de ad heads of the tall fennel drooped sadly amid huge fluffy dandelion clocks One solitary iris bravely thrust its head from a rock above us St. Hilarion , the founder of Palestinian monastIcIsm, died near Pathos in 371 AD. There is no evidence that a monastery existed on this site, though the chapel which we visited was part of the Byzantine castle.

Friendly Turkish soldiers patrolled the gates of the castle, while those off duty strolled in the grounds or sat in a vine-shaded garden drinking coffee or Coke

The Byzantine castle which existed on this precipitous mountain peak was capture d by Ri char d Coeur de Li on in 1191. He entrusted it to the King of ] erusalem, Guy de Lusignan , in whose

The mona tery and church is built over the tomb of St. Barnabas , who wa a native of Cyprus. It is beJieved that he was killed by the J ews at Salamis and that St Mark hid his remains in a rock tomb outside the walls of the city. The tomb was forgotten until 477AD when the saint communicated its whereabouts to Archbishop Anthemios of Constantia When the tomb was opened, the identity of the dead occupant was established beyond all doubt by the fact that a manuscript of St. Mathew's gospel, written in St. Barnabas's own handwriting lay near the human remains . The Archbishop at once took the gospel to the Emperor Zeno of Constantinople, in the expecta lion that the narrative of this mira cu lous revelation would resolve arguments about the status of the church of Cyprus. His hopes were realised and the church was gr a nted independence. The Archbishop was invested with the right to wear a cloak of imperial purple, carry the imperial sceptre and sign his name in red ink These privileges exist to this day and are the favourite subject for the Holy pictures painted by the three priests who have lived in the monastery since 1917. They came to the monastery as young boys and were brought up ther e. Now they are white bearded and dignified in their habitual bla ck cassock and cloaks. They obtain a steady living by painting icons not only for their own Famagusta beach

church but for others. We met and chatt ed to the brothers, who loved being photographed with visitors. Salamis lay before us in the hot afternoon sun. Our guide marshalled us rou nd Roman baths, stadium and gymnasium, giving uS fascinating data with a bright , imaginative commentary. According to legen d , substantiated by recent dis cove ri es, Salamis was founded by Teucer after his return from the Trojan war. In turn the Assyrians, Persians, Egyptians and Roman s ruled Salamis. Paul an d Barnabas founded a Christian community there and later a series of earthquakes, followed by a tidal wave, devastated the city. It was rebuilt by the Emperor Constantine and renamed Constantia. Again it was devastated , this time by Sara cen raids over a long period. Excavations carried out in Salamis in 1960 reveal ed a Roman theatre thought to be the largest of it kind in the Middle East. Wh en the Palae st ra was discovered its columns had fallen, but they have now been re-erected and most of the statuary from the site has been transferred to the museum in Nicosia. A late discovery has been the bottom half of a mosaic showing Apollo kneeling on a rock. Near the esti mat ed centre of the ancient city is a Byzan tine cistern, an d further on to left of the road, the great Basilica, whi ch was thought to be the metropolitan church of

St. Epiphanos, Bishop of Constantia.

Feeling rather weary after our climb around Salamis in the ho t sun, we were taken to a hotel nearby, and in the cool rece ption hall Mr. Woodhill presented us to the President of St. John Ambulance of Cyprus, D[ Jordon Christodoulides.

Then we m et Dr. and Mrs. Melatiou, Mr. and Mrs. Zodiatis and Mr. and Mrs. Psatha s. Tea was set out for us on a long table on the terrace and we chatted happily with our hosts.

When our guide, Miss Constantiniv, bade us farewell, she said that she would be joining the Brigade in Cyprus. We asked our driver if he would join also. He laughed He was already a member.

From Cyprus we flew to Beirut in the Leb anon, an d I must say we weren't very impressed with the journey from the airport to the hotel. Litter was strewn everywhere along the roadway, and heaped anywhere into unruly piles But our hotel was clean and comfortable, with large rooms and adequate air conditionin g.

The Lebanon is a land full of memori es of an ancient past. Its conquerors include Agrippa, whose daughter Augusta Berytus gave Beirut its name. The Roman s dominated this small

ST. JOHN AMBULANCE TOUR SEPT. 1973

Rome: Sept 15th, 16th, 17th including a visit to THE VATICAN

Jerusalem: 18th -26th Pater Noster Church Gethsemane, the Spring of G ihon. Bethlehem, Shepherds Fields , and ST. JOHN OPHTHALMIC HOSPITAL Mt. Calvary , Church of the Holy Sepulchre

country, which is half the size of Wales, for three centuries, and the Beirut Law School was the greatest in the Roman Empire. The Crusaders took the city in 1110AD when it came under the crown of Jerusalem, but soon after, in 1187, Saladin took the city for the Ottoman Empire, which ruled it until 1918, when the Turks were ousted. But this was not achieved without severa l Lebanese being hanged defending their country, and bronze statues in the Pl ace des Martyrs are an impressive memorial to these men.

Our guide in the Lebanon was Elsie, amiable and well-instructed, who deftly marshalled us into the coach, freeing us from the persistant and over attentive taxidrivers and pedlars. One Arab pedlar carried an enormous girl -shaped balloon in his arms and dangled cheap novelettes before our noses As we drove off in the coach to the National Museum, Elsie gave us information about the town of Beirut through the microphone.

The population of Lebanon is mostly Christian; but the Prime Minister is always a Moslem , the President always Christian; banking is very important in Beirut , and it is known as the Switzerland of the Middle East.

Standing out against the sunbaked stone work of city buildings, the misty lavender blue of the Jacaranda trees delighted us. Elsie said that one year the

Led by Mr. G Woodhill

Jacaranda tree produces pink blossom the next year blue

The National Archaeological Museum is an absolute treasure house, most of the exhibits being found in Byblos. We went through the various galleries: of the Alphabet, showing a stele (a stone) of the Phoenician era as yet undeciphered; of the Collossus ; of Rameses II; and of Eshmun. In the Hygiea Gallery was a mosaic of Bacchus which was found in the theatre at Byblos. Another mosaic in the Gallery of Jupiter, Byzantin e and very beautiful, depicts the Good Shepherd in the attitude of Orpheus, surrounded by wild animals.

In the Central Hall is the sarcophagus of Ahiram, king of Byblos. Display cases show the evolution of civilisation in Lebanon from prehistoric times

Although of ancient origin, Beirut offers little in the way of monuments and archa eological curiosities. The only noteworthy monument is the Great Mosque of Omar, constructed over an old Crusader church dedicated to St. John the Baptist, which in its turn was built over the debris of a temple. A relic of st. John, believed to be an arm, is kept in a

The St. J ohn tour members at Byblos

sarcophagus whi ch ca n be seen against the south wall.

We were taken to a carpet warehouse where coo l drinks were offered to us whilst carpet after carpet was unfolded for our inspection. There were Bokara Sheraz and Kurdi stan carpets from Sa makan from Turkishtan- Turkish' Caucasian, Turkoman and Beluchistan: Two particularly beautiful designs were The Tree of Life and the Prin cess Bokara.

The value is not in the size of the carpet but in the fineness of the knot. In the East, carpets are hung on the walls; if they are placed on the floor it is a sacrilege to walk on them without removing ones shoes. When cleaned they are hung in the open air, lightly beaten, and then gently sponged with alcohol. A vacuum-cleaner is never used on them.

On our way to Byblo s the next day we came to the Dog River , which flows amongst boulders and maples, and supplies Beirut with its drinking water.

Winding up its southern cliffs is a road out by the ancient Egyptians, WhICh our coach climbed. On the rocks we saw inscriptions carved by the proud conq uerors, the earliest ones III

II passed this way after h IS cam palgn agaIn t the Hit tites and :etold the tal e of his exploits in pictures 111 the temple at Luxor. In 587BC, while hIS army beseiged Jeru sa lem Nebuchadnezzar al 0 carved his memoriai on these cli ffs. A year la t er Jerus al em fell and the Temple was destroyed. Nothing more was carved on the rocks un til the Romans came, but successive empires have left each others monuments as they were cut. On the southern bank a tablet records the Allied capture of Dama cus in 1941.

The river is given its name after Anubi s (the dog), the Egyptian god who as isted Isis in finding her lost Osiri s. Osiris wa the child of the earth god and the sky gO.ddess and married [si s, creator of green tlungs. Osiris, th e deity of fruit and harvest, was killed by his brother, who floa ted the body ou t to sea ina wood en chest and it landed on the shores of Bybl o . There, an erica tree grew where [SIS found the coffin. She took the body back to Egypt, where Osiris's life wa restored, and he became the lord of the underworld.

We vi ited the cave of J eita, the Source of the Dog Riv er. These cave were first explored in 1873 by two engineers form the Beirut Water Company. Using a raft, and lighting their way with manganese wires, for ten hour they followed an underground river into the mountain without coming to its end Since , other explorer hJve penetrated four miles along this underground river, but they too have not found its end. ow the beautiful rock formations of the caves a re illuminated, howing the richness of the natural architecture rising up like a gothic cathedral. Stalactites and stalagmites are everywhere and the faint rumbling of the flyer can be heard below

Crossing the Adonis river, we learned that Adonis was acred to Byblos and the surrounding countryside. The love legend of Adonis and Aphrodite, of course, has inspired ome of the world's greatest poetry. One day Adonis \Va hunting in the wood near the Afqa grotto when he was gored through the thigh by a wild boar and died. Aphrodite found her wounded lover and tried t o bring him ba ck to life Her grief was so great that the gods decreed tha t her lover should return to her from the underworld for six month s each year. Afqa is where the lovers had their la st tryst. When winter i over, the rUShing water pours with such force down the grotto that it remove the ferruginous soi l in its path and so becomes red in co lour. This phenom enon is regarded as the blood of the wounded Adonis ; and the cri mson anemones gr owing on the hillside in the spring are also sy mbolic of the blood of Adonis and the tears of Aphrodit e.

Byblo s's Crusader castle with its square tower was built from the stonework of the Adonis temple. The knights always built on ancient sites, using salvaged slone and very littl e wood. British canon b alls fired in 1840 , can be seen lodg e d in the walls of the castle. Passing through the galleries and chambers, we ca me onto a site of ancient walls and temples, now under a garden of weeds and pale mauve hollyhocks, javatera, an d aspho d e l, which is the flower of the dead.

As early as 4000BC Bybl os was the commercial centre of the Syrian coast, and was even greater than lhe well known cities of Tyre and Sidon. Today its port is a quiet fishing village of ageing Roman stone. Perhaps nowhere on earth are so many generations fused. We returned to Beirut for lunch. Some of us decided to have just a snack on the hotel terrace, but soon we were surrounded by smart waiters who looked in astonishment when we explained what we wanted. Our table was suddenly laden with the most inviting dishes: sesame cheese, vine leaves wrapped round spiced rice and m.inced lamb, cold fresh salmon and salads of all descriptions. We sat mesmerised, too weak to resist but also alarmed at the cost of all this. It was the best meal that we had in the Lebanon and Syria, and the cost was fair.

It was in St. George's Bay, in the Leb anon, that the dragon was slain. St. George was born in Lydda, Palestine, and became a Roman officer. H e was sent to Brit a in where he became a Christian. He was martyred under Diocletian. How he slew the dragon is a mystery But the story goes On ce the whole population of Beirut was frightened by a monsler who took possession of a small lake in the centre of the town. The people beseeched the ruler to give his b eautiful daughter to the dragon to appease it. St. George, seeing the princess b eing led to her doom , rode ahea d and slew the dragon as he rose from the lake

This legend is based on an earlier tale of when th e patron of the city rescued Beroe and Andromeda from the sea dragon Pont us

Leaving the heat and humidity of Beuut our coach took the road which climbs in wide bends between the slopes of Jebel Keniseh and Jeb el Bantk As we climbed to the pass of Dahr el Baidar the air became fresh and cool and our' ears began to pop as we climbed to over 5000 feet. The views were splendid, the terraced hillsides dotted with villas. Wild flowers grew everywhere, and there was snow on the mountain peaks. In one village our guide Elsie pointed out a Lebanese cedar tree.

The mountain people venerate the cedars, whi c h were described in biblical times 'as exalted above all trees of the field'. In the winter their branches contract and point earthward to support

The Lebanon - a land full of memories of a n a ncient past

the weight of the snow, but in the spring they extend their majestic boughs, lifting them to heaven in praise of God.

Soloman built his temple of these trees and David built a palace. The Romans used the cedars of Bybl os to build their ships; and the precious resin for embalming their dead and preserving the papyri of their sacred books.

Our road descended to the beautiful Beq aa Plain , enclosed to the west by Mount Lebanon and to the east by the Anti-Lebanon chain. We passed through apple orchards and vinyards and occasionally aw herds of black goats, with their long floppy ears, poultry farms, and bullocks drawing ploughs. Baalbek, City of Gods, is now a small town mostly inhabited by Muslims. The Arabs say that it was thrown up by Cain against the wrath of God, or that Soloman, corrupted by his foreign wives, gave his heart to Aphrodite and built Baalb ek in her name. The Greek Seuicid kings called it Heliopoli , city of the sun, and the Roman Emperor Augustus, carrying out the idea of Jul ius Caesar, built these monumen ts in the 1st-century AD. Temples were built for the gods Jupit er, Bac hus and Venus Later Christian mlers tore d own the pagan relics and put up a basilica Arabs u ed the temple area as a fortress and finally an earthquake JJ1 the 16th-century

destroyed much of it. In spite of this, the majesty of Baalbek remains. The six colum ns of Jupiter's temple, the acanthus leaves at their tops can be seen, are in rose granite. They are sixty-five feet high, and aU that remains of the 54 columns which originally contained the temple. The temple of Bacchus stands more complete than any in the Lebanon. It is flanked by co lumns standing 62 feet high. The friezes of the inner shrine remain, and also the steps to the throne. From the portico ceilings the faces of the carved gods have been chipped away. The doorw3Y to this temple is most beautiful. Beneath its lintel, there is a carved flying eagle, garlands of flowers, ornamental bands holding poppies an d corn, vines and ivy interflow, and the eggs from which Aphrodite was hatched from a dove.

The unique little temple of Venu must have been exquisite. Venus was the symbol of grace and beauty, of love an d fertility, and the most gentle and most female of all the godde ses. All this was reflected in her temple. Astarte, consort of Baal, was identified with the earth and fertility. Later she was Aphrodite or Venus. Along the road to Damascus, Nature herself had prepared a welcome fit for any god.

(Continued next month)

Salamis, in Cypru s, was founded in 1184BC

Cadets Celebrate

LEE YEAR DRAWS TO A CLOSE

CAMBRIDGESHIRE-Ap art from a church service at Ely Cathedral, a field day during March, and a jubilee cadet party in Cambridge during September, SJA Cambs organised an essay competition for all-comers aged 8 to 16, which resulted in 400 entries. There were two winners, one being Cadet Carol Sweeney of Cherryhinton Combined Division, who were flown to Jersey for a weekend, meeting SJ A on the island.

DERBYSHIRE- Celebrations included a junior sports day at Worksop cricket field organised by 'D' Corps and attended by more than 2000 people As well as athletic events, there was a dog-handling display , a tug-of-war in which 'D' Corps took 2nd prize, and an 'o ldies (over 40s!) race in which Corps. Supt. J. W Hancock finished second.

A highlight of 'C' Corps (N. Derbyshire) celebrations was an enrolment ceremony, attended by Col. Peter Hilton , Commander/Commissioner, of 80 cadets.

In October, 800 cadets from the county attended a special jubilee service at Derby Cathedral.

LONDON DISTRICT-Heston and Isleworth Nursing Cadet Division organised a first-aid course for I I to 15-year-olds in the Borough as part of the jubilee celebrations.

36 youngsters enrolled for the course, in which nursing cadets acted as patients and assisted in demmstrations 28 of the course gained the certificate of the Essentials of First Aid, and they all received a special commemorative certificate.

From this idea , a new first-aid competition for local youth organisations has been organised, with 20 teams so far competing for two c u ps donated by Alderman T Pauling, President of 197 Ambulance Division.

These 'outside' activities have produced a fair number of recruits for SJA

STAFFORDSHIRE- About 90 cadets from North Staffs attended the third annual training day on October 28 organised by Sneyd Green Adult and Cadet Division. As well as films and talks, the cadets treated simulated casualties, and thoroughly enjoyed this jubilee 'special'

SURREY -Fnmley and Cnmberley Ambulance Cadet Di vision he ld an unusual cont ributi on to jubilee year a fiv e-a-side football tournament for ambulance and nur sing c adet Entries were a great that the even t had to be held on two day , October 8 and 15 Cranleigh were winners of both junior and senior section of the ambu lance ca d ets; G uildford No. 2 were winners of the junior nursing cadets; and Bagshot of the senior nursing cadets.

Cadet Pe ter Ford, of Frimley and Camberley, unfortunately fractured an ankle whil e playing, but he turned this set-back int o success by charging 5 pence per signa tur e on his plastered ank le and so far ha co lle cte d £3 towards the new ambulance fund.

Worcestershire held a jubilee dinner and dance attende d by the Chief Staff Officer for Cadets, Col. P. Adams (centre), and three founder members of

Shrewsbury's popular drum and bugle

DivISion'.

jubilee flower display in Spring Park Matlock, was designed by Derbyshire's ASO H. Baxby

Ambulances

ONE NOTICEABLE FACT of the news

that pours into our office is the increasing number of new ambulances that are being acquired by St. John units in Britain and overseas. Which is a very good sign, of course, as mobility is an inescapable and essential facet of today's world. To some people, going to the moon may seem an awful waste of money, but the long term objective of such an exercise is not simply to travel great distances; it is what is done after such travel is established that is important. For St. John, mobility plays the same role.

Hence the continuance of articles on ambulances, a subject which should become a regular feature of the Reviewso news on ambulances, design , ideas , or their operation will be most welcome. And while we're on the subject , although many units cannot afford to buy their own new ambulance, they do have a say in what sort of vehicle other organisations - such as the Round Table, etc (See Around and About, page 10) - buy for them The Review would like to thank all these organisations who help to supply the tools for St John to do its work.

F.D.

IBIS M3 LTD, Kendal

Latest addition

Wheel pans and a

fastener for the stretcher have been installed , togeth er with a stainless steel

tra y which may be extended some 20ins beyond the opened tailga te of the vehicle t o ai d oa ding and unloading.

Oth er modifications to the interior of the Volvo include a recess and retaining clips for oxygen bottles, an electrical point for a premature baby unit, and roller blinds on the side windows.

External modifications comprise a removable illuminated 'Ambulance' sign and blue flasher beacon

THE FLOATING GENERATION

from Alan Sharke y, Ambulan ce Memb er My. V S S mith, in h is l etter in the November Review, appears to h ave taken my letter in the August issue very literally My letter was i n te n ded to be taken seriously , but I did exaggerate in o rder to make the point. I am very pleased that my letter should hav e provoked such constructive comments from Mr. Smith an d My. Farrow.

T he point about CO ranks needs a further explanation. At prese nt the NC O rank see m s to be the only way in which some responsibility can be given to members at divisional level. NCO ra n k p r ovides a means by which 'enthusiasm, skill, and leadership p otential' may be shown. If any other way could b e found to p rovide su ch a means then the opportunity should be taken to replace 'Sergeant' and 'Corporal' with a more suitable ' rank perhaps denoted by something similar to the members nursing exam star instead of the rather conspicuous and para-military chevrons. A division could then 'promote' to such a rank those members who actually involve themselves in the run n ing of the division, or who have some relev a nt qualification or skill to offer (such as full time ambulance staff). The one difficulty with this idea is that there might be some divisional superintendents who take the whole running of the divisi o n upon themselves (and deserve great credit for doing so) o nly t o wonder why some members lose interest. Worse still are those di visi ons where administration seems to fall within a small clique to the complete exclusion of all others

P e r haps the answer cou ld be for members of a division to divi d e into small working groups , each group responsibl e for p articula r duties or other activities? The individual members of the groups would then have an opportunity to do more than just m ake u p numbers. P erhaps divisions could consider establishing Sections' in nearby areas, thus giving keen members a real opportunity for doing a worthwhile job?

H aving dealt with the question of divisional duties , I am interested in My. Smith's suggestion th at it is possible to inv o lv e onese l f in organising training of an adventure type at divisional, area an d county level etc.'. P erhaps in a more en lightened cou n ty such as Buckinghamshire such opportunities d o arise. The training course would seem to provide an opportunity for those capab le of undertaking such activities to be identifi e d at co unt y leve L Sure ly other counties would benefit from similar schemes?

Mr. Smith makes the point that numerous young people float away between 15 and 25 due to a lack of direction an d a feeling of futi l ity at not being able to get things done quickly enough. He r efe rs to m y defeatist attitude , but am I not just expressing that feeling of futility? As a married man with two very young children, there is a limit as to how long I can continue to give up my spa re time if I fee l that to do so is serving no useful purpose. I a m fort u nate in that my wife also ha s an interest in St. John H owever, I can well understand why so many of around my own age (24) 'float away'.

I should like to make one final point: that is that there is a very wide diversity between divisions in different parts of the country, and my suggestions may be totally irrelevant to some (such as in B uckinghamshire), but the general idea is the same a ll me m bers need a real interest in what they are d o ing , th e level of t h at interest being geared to the member's own capabilities. H avant, Hants A lan Sharkey.

PRIORITIES

from Col. R Ol1 e r e ns ha w, Surge on -i n -Ch ief

I really cannot see what myoid friend Edward Tort e ll (Review, D ecember) is worrying about, except that he is still quoting from an obsolete manual! The third (1972) edition puts breathing first with some frequency - see, for example, pages 12 , 14 , 72, 14 I. Agreed tha t on page 89 we say that 'The aim is to stop the blee d ing immediate ly ' but it may not, as Mr. Tort e ll rightly says, be possible to attain all our aims simultaneously. This is surely one of the occasions when w e must take a ca lc ulat ed risk: if the patient does not breath again pretty quickly he will di e , a nd the bleeding will most certainly stop! Th e body can los e a lot of 20

READERS NEWS from SCOTLAND

VIEWS

Readers' views and opinions, which should be sen t to the Editor although published are not necessarily endorsed by the Editor 01 the Order of S1. John an d I s Foundations. Although readers ma y sign plJblished letters With a pen name , writers must supply thell name and address t o the editor

Ballintrodo or T empl e ( Midlot hia n )

blood before it dies , but it cannot run without breathing.

As a matter of interest I have never met a situation wher e h ad to make this choice. I wonder if Mr. Tortell has , and if 51 W ha t were the circumsta nces?

FAINTING

from Col. R. O ll eren haw , Surgeon-in-Chief

The simp le precaution of keeping weight off Lhe heels is right! m en t ioned by Col. R obinson (Review, December) as well-established piece of military teaching. And it works. Th; probable reason is that in order to keep one's weight forward It is necessary to main tain some degree of con traction in the e! muscles, especially those of the calf. This contraction is no ! constant, and it provides an clement of pumping of blooa upwards through th valves of the great leg veins. There is thl! less chance of blood 'pooling' in the limb and a better circulati or is probably maintained to the brain (T do not think that sho d transmitted from a fall on the heels has anythll1g to do With fainting.) There are, of course , many o her factors which ca " operate in young folk hunger after too early a breakfast, J fu l bladder or rectum, or even sheer excitement palling In boredom.

BALLINTRODO was one of the eight baronies of the Order of St. John which were included in Qu een Mary's charter of 15 63/4 in favour of the first L ord Torphi chen. This charter was granted on payment t o the Que en or her officials of the larg e sum of 10 , 000 crowns of the sun (ro ughl y £50,000), but it was a good tit le d eed, enabling Lord Torphichen to borrow a great part of the money from an It alia n banker who was repaid gradually by the sale of lands the balance of the loan was paid off after the death of the first Lord Torphi chen by his great nephew and successor. The name of the barony was spe lled in man y different ways (Balantra d och, Ballantrodo, etc), but for many years the vil lage and church have been known simply as Temple. It was given to the Kni ghts Templar in about 1124 and came to the Order of SL John as a result of the papal decree of 1312 which suppressed the Templars and ordere d that their properties be transfe rr ed to the Hospitallers. Because of the confusion caused by the wars in Scotland it is not known exactly how the transfer took place, but there is extant a

WALES

PEMBROKESHIRE St. John Ambulance has offered to provide an inshore rescue b oat to help meet the serious inadequacy of lif esavi ng facilities arou nd the county's coast-line.

charte r of 1354 in which Broth er Thomas de Lindsay, Master of the Hospital of St. John of J erusa lem in Scotland, described proceedings of our chapter held in our principal court at Baltrodokis'.

Temple is a village on the South Esk bet ween Gorebridge and Peni cuik and it can be reached by the B 6372 road. The village is built on high ground, but down ncar t he riv er an d opposite the presen t parish church (built in 1832) ar e the roofless remains of a 13th- century building which is in surprisingl y good order. It is littl e known because it lies behind a wall and cannot be seen from the road. The cross on the gate pillar in this wall is supposed to have come fro m the original church.

It is difficult now to d efine the boundaries of the barony administered from this site, but they certainly included the Amiston estate. In the Chartulary of Torphichen (1581-96) t here are 20-30 entries relating to Ballintrodo. We find, measuring from Temple Church, Carrington 11,4 miles to the north, Harvieston 2Yz miles north- east, Stob s (in Gorebridge) 3 miles north-east and Crichton 5 miles north-east. To the south

and eas t are hou ses and farms called Outerston (1 3,4 miles south-east), Y ork sto n (1 Yz miles due south), Esperston (2 miles sou th-east) and Halkerston (214 miles east). Another poss ession was Au chindinny Brigs or Lonestan e (4Y2 miles west -nor-west) and one of the su mmits (1,510 feet) of the Moorfoot Hills , 4 miles south-south-east, is st ill known as Torfichen HilL

Lands at Gullane and Aberlady also belong e d to the Order of St. John and so may have been attached to the barony. Charters concerning land at Gullane were is sue d to John Bryson and David Young in 1582 and 1583 Lands a t Aberlady were transf e rr e d to W Robson and Tait in 1583 and 1586; and in 1620 a charter granted the estates of the Friars of Lufness and Aberlady to P atrick Hepbu Tn Indeed transactions concerning properties in th ese areas were still taking place in 1622-27 . There are also en tries in the Chartulary regarding a Muir House , a lthough it 15 uncertain whether they related to lands near the Moorfoot Hills, and therefore within the barony of Ballintrodo , or t o the lands of Muirfield near Gullane now owned by the Honorable So ciety of Edinburgh Golfers. It is possible that two golf courses lie on lan d which once belonged to the Order of St. John J H. Calder MacLeod

OVERSEAS

SOUTH AFRICA

I hold a purely personal view that, however much nuisJncc may be to the adults cadets shou ld always do a bit of marchio! to take their minds off the inevitable waiting. HQ

HOLIDAY DUTY

from R F Hayward

R. Ollerellslial

[n th e November R eview. Ri chard Gibson made reference to visiting resorts whi le on holiday and finding St. J ohn posts c losed. This is very true . It happened to me Lhis year. While on holiday an accident occur r ed on ly a few yards from one of our huts, but I had no kit with me.

I know what you ar e thinking improvise but that is nol easy when you are wearing only swimming Lrunks and a flims) shirt (even less easy if you happen to be aL a naturalist camp)!

My idea is that a ll first-aid posts, huts, etc, s h ould be fitted with a lock w hi ch is universa l to St. J ohn. Then all cou ld have a pass key. And the idea could be taken further Whe re there is no space for a hut there cou ld be a small cupboard co ntainin g kit. And this idea cou ld app ly anywhere in th e co untry not only at the easide.

R eading, B erks

R. F. Hayward

Th e offer was made by the Chairman of the St. John Council, Pembroke ship-bu ild er Mr. Ri chard Ha yes, when he spoke at a recent open-air meeting and rescue demonstration at which delegates representing nearly every loca l authority an d rescue organisation in the county were present.

Th e demon stration and meeting were organised by SJA to draw attention to the need for more rescue units arou nd the coastline.

Mr. Hay es, who told the meeting that the lack of faci liti e co ncerned the Council, said that they were offering a re sc ue boa t if other organisations would co-operate in etting up more rescue units a lon g the coast lin e.

My. Haye s sai d : Sin ce the fundamental principle of St. John is lifesaving, we are particularly anx ious to be associated with any m ove towards improving the present situation.'

He hop ed Lhe d ele gates, wh o included members of youth groups, would return to their organisations and consider

_________________________ - ,..- s ugg estio n for improving lifesaving cover arou nd the coast.

Editor: Due to a shortage of space {/ number of letters have beell held over till next month.

St. John would b e happy to playa

At a r ecen t investiture of Th e Pri ory for South Afri ca. (Left) Mr. Sarah Pand ay - Serving Sister; (right) the Superintendent of the St. John Eye Ho spital in South Africa, Dr. J. W. Sco tt-MillarOffi ce r Broth er; (below) MI. Jo seph TsamboServing Brother.

major role in setting up an organisation or a unit, said Mr. Hayes, who added that the number of organisations represented at the exp loratory meeting indicated the degree of co n cern in the area. Del ega tes wat che d the demonstr atio n by teams from the National Coastal Re scue Training Centre at Aberavon, under its director, Cmdr. Charles Thompson and Penyb ont Surf Lifesaving Club.

* The oldest Knight of the Order in Wa les, Colonel Ri chard Conan Robert s, 93, of Wr exham, di ed on ovember 30. CoL R oberts was made a Kn ight of the Order of St. John in 1922.

News from

the Divisions

DEVON-At the Exmouth Ambulanc e Division s annual awards night, this year a special presentation was made on behal f of all Exmouth divisions of a transistor radio to the retiring ambulance superintendenL, Mr. F. N. Bastin, by th e new superintendent, Mr. S E. Nicholson

Mr. Bastin, who was thanked for hi s 45 years of service, the last 17 years as supt, previously as DO and corporal, is to go on the Brigade reserve. He was made a Serving Brother in 1958, an Officer Brother in 1966.

His wife, Mrs. V. Bastin, who still serves as a corporal, was presented with a certificate of vellum last April, having been a nursing member since 1943.

LONDON-Th e 19th annual corps dinner and dance of the 89 (London Transport) Corps was held on Nov 18 and attended by over 140 members and friends , the principal guest being Lt Col. R. A Payne, Deputy Commissioner. The Corps was congratulated on its 48 years of continuous service.

SURREY -On Nov. 17 the 43rd Ep om Cadet Division held an enrolment ceremony, for 6 juniors and 9 cadets coupled with the presentation of award s. London District's jubilee cadet poste r competition brought first prize in the junior section to Linda Richardson, of Epsom, and first prize in the over 11 s to Mary Cooke, of Croydon.

NORTHANTS-Brig ade members are always on duty at the meetings of the Red Star Bangers at Little Add1l1gton, Northants and at a recent event one of the drivers was seriously injured in a pile up. He received prompt attention from the men on the spot and the organisers claim that they saved his life. In consequence they have donated £200 to the Brigade. This is being used to obtain a resuscitation outfit which will always be available at future meetings at the track.

A striking tribute to St John Ambulance was paid by the Royal British Legion of Leicestershire and Ru tland at their annual Festival of Remembrance at the de Montfort Hall. An ambulance member and a nursing member were stationed at either side of the hall and as the items of the programme changed they advanced and took up positions on each side of the steps leading to the stage, retiring when it was finished. They were, incidentally, able to assist some of the aged veterans to negotiate the steps, a

gesLure that was appreciated as they included 'O ld Contemptibles The you th organisations in the muster in c luded ambulance and nursing cadets, while a fine contingent of adult members was on duty otherwise .

OBITUARY

MRS. SARAH HENDERSON, Assistant County Superintendent (N) Berkshire ; member of st. John Council appeal committee . Died November 29, after a fall from a hor se.

CAPT. HAROLD PITCAIRN HENDERSON, RN, CBE, DSO, County Commissioner, Hants, Commander of the Order of St. John MRS. DOROTHY MARY Y ARKER , Superintendent, East Cleveland Division, N. R. Yorks. Serving Sister.

Suffolk's Mildenhall Combined Cadet Division, formed 2 years ago recently held their first enrolment ceremony, conducted by SJA Commander Major R S Schreiber and Mrs. Schreiber (centre back row)

(Photo: Grimsby Evening Telegraph)

Lord Cozens - Hardy, Bailiff of Egle (right) (Photo: Lincolnshire Free

Press)

REVIEW CROSSWORD No.1 (73) Compiled by W. A. Potter

ACROSS:

1. End product of protein meta bolism a constituent of cure applied. (4). 3. Respiratory tract infection from broken chin in strange orbits. (l0). 10. One who is indifferent to pain and pleasure. (5). II. Epileptic attack in good health. (3). 12. Initially an in terna tional organisation for relief of su ffering. (5). 13. Convert venous to arterial blood, as in the lungs. (9). 14 With enteritis it is superfluous to become a competitor. (5). IS. Selects diseases involving liver and brain. (5). 17. Many gusts producing rapid, involuntary movements of the eyeball. (9). 20. Early part of the way into Europe? (SA). 23. Suitable attire in which to tend a wound? (5). 24. Part of nurse's uniform put on after April. (5). 25. Strike a blow on joint for deformity of lower limb. (5-4). 27. Fractured ulna and radius in referring to natural satellite. (5). 28. Tree which is essential part of Michaelmas. (3). 29. After hesitancy, communist did the wrong thing. (5). 30. SR saw name changed for reaction diagnostic of syphilis. (10). 3 I Ruse for employer. (4).

DOWN:

1. Like the tooth that continued to give pain. (9). 2. Bla c k wood composed of broken bone with final additive (5). 4. Song of referee before inclement weather. (7). 5. Guts men used for aromatic flavouring of medicines. (7). 6. Bursiti acq uired in service, evidently. (lOA). 7. Often malignant ovarian tumours with very small particle in middle. (9). 8. Saint takes air for a sin gJe step. (5). 9. Accomplice with pluck supplies muscles of neck and shoulder. (9.5). 16. Coastal feature encircles articles protecting patient from wind and rain. (9). 18. Affirmative response all year except final quarter. (3). 19. Hold up for hose. (9). 21. Supporting feature in many old buildings. (3-4). 22. Deformed Roman to do duties at the entrance. (7). 24. Feeling in radi:mt health? (5). 26. Nostrils are between poles. (5). SOLUTION TO CROSSWORD No. 12 (72) ACROSS:

1. Running nose; 7. A.uk; 9. Torsion; 10. T.reason; 11. ail ; 12 Renal; 13. Snap ; 16 Tight ; 17 Alopecia ; 19. Abnormal; 21. Stout ; 24. Chew; 25. Penny ; 26. T.alc: 29. Ill- w.ill; 30 Emeti cs; 32. Gas; 33. Kl eptoman a. DOWN:

1. Rot ; 2. Nur.sing; 3. Iris 4. Ginger ; 5. Outfalls; 6. Ewer; 7. Arsenic; 8. Kineplastic ; 11. Not catching; 14. Start; 15. Spasm; 18 Lam .e lla.e ; 20 Needles; 22. Ovarian; 23. Inj ect; 27. Sick; 28. Germ; 31. Sp a.

News from the Divisions (Cont.)

Retiring N Somerset Area

Comm issioner Dennis Clark gets a big thank you at a recent SJA social evening. (Photo Weston Mercury)

Cheshire Bredbury an d Romiley members AIM A. Mansfield and D/SuPt. (R) Miss M. Grimshaw receive letters of commenda tion from the Mayor of Stockport (Photo: Stockport Advertiser)

NATIONAL FIRST AID COMPETITION POST OFFICE AMBULANCE

Wales & th e Marches Swansea II PO

N. Ir eland, Belfa sl C;-'10

w Region GMO

Scotland Motherwell Branch POAC

.W. Region Pre ston G:'Il0 (Blackpool)

Ciil'>s iflf'd Rilip')

Semi di splay £3.50 S.C. I (minimum £1.75)

8D iJer word !lnlnlr1lUI11 £1.00) Box. No. 25p extrCl.

CJIlJll111 Depth 10"

PrO(t'ss O.ffset Lith o Copy Od te. 8tl of th e 111 on tIl preceding publication.

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MOORFIELDS EYE HOSPITAL CITY ROAD, LONDON E.C.l.

Vacancies eXist for State Enrolled Nurses to enter for the Post Enrolled training in Ophthalmic NurSing. Twelve months course, of which two months are spent in the School of NurSing Moorfields Certificate of Proficiency and Medal awarded to successful candidates who are also prepared for the Proficiency Certificates of the Ophthalmic Nursing Board. Opportunities for promotion and practical responsibility In the specialist field of nurSing

Apply to Miss M B MacKellar , Matron

MOORFIELDS EYE HOSPITAL CITY ROAD , LONDON, E.C.l. ( 26 )

Candidates accepted at the age of 17 to commence an 18 month course of training as Ophthalmic Students. Moorfields Medal and Certificate awarded to successful Candidates. Well eqUipped School of Nursing, Successful candidates, on completion may enter the General Training School of their choice. Comfortable Nurses' Home in Kensington within easy reach of the Albert Hall, Victoria and Albert Museum and Theatres, Tennis Court, Active Social Club

Apply to Principal Nursing Officer. (8)

BALL PENS, Diaries, Note Pads, Keys, Fobs,

JOHN

AT RANDOM

by Watkin W. Williams Deputy Commissioner in·Chief

[T ]S ALWAYS a specjal deEght to offer our congratulation to those members of St. J ohn Ambulance who have been honoured by Her Majesty

The Queen_ In the New Year Honours an MBE was awarded to Mr. C. J. Parry, who in thecourseofhis30 l ear s St. J ol1n mem has been Brigade Secretary for Wales ince 1960 and for the past five years ha also been Chief Staff Officer to the Chief Commissioner for Wales. Mr. E. R. F_ Pogmore, Deputy Commissioner for fottinghamshire , has likewise received an primarily for his services to the 1 ational Coal Board, and during hi 14 years' Brigade member hip he ha been among tho e who have done mo t to strengthen the very close and happy relationship that exists bet ween the Board and our Foundation.

The ha been awarded to Mi s V. Lloyd. who for more than 30 years has been Divi ional Officer of the Redhill and Reigate Nursing Division. during whjch time he has performed the truly amazing total of orne 23,000 hour of voluntary Brigade duty in the ick wards of S1. Anne' Ho pitaL Redhill and in the Elcctfo-Convul ive Therapy Clinic at Redhill General Hospital. a well as in transporting patient and C<.l'ualties and performing fir t aid dutie on public occa ion; it i <.l very real joy to ll all to know that llch a mngnificent example of dedicated service in the highest traditions fo the Order of t. J ohn should have recejved tl1i recognition from our overeign Head. Another recipient of rhe BEM i - Mr. A. R. G. Pocock, who for the pa t 35 year ha an outstanding record of ' ervice to the Brigade in ollth Wale, culminating in his a Commis -ioner for South lonmouth hire.

I C ON FESS

Confession is g oo d f o r the o ul , s o I think I'd hct ter co nfess to you that abou t a couple of yedrS ago I wa - s o carele as to 01110\\ the v alidity of my nL!r ing certificate to expire, and hame compelled me to remove the nursing tar that I had for man;. years worn on my uniform _ It all came about through 111;' VO'A ing to m;. self. when [ heard that a revi ed edition of the nur ing manual \\ as due to appear (1969), not to offer nursing a \'vell a fir t aid in my re·exam till I'd attended a full OLwe of lectur e and practical work on the new manual. That wa all very well, but the problem was how to fit in eight or more can ecutive weekly attendances at a clas without eriaL! cia he with my eXi s ting Sl. John and other engagements: and hy the time that tw o successive attempts to do this had failed, I found to my

( Continu ed V II nC!xl{Jage/

Pr incess Margaret with Peter Ustinov and Brian Bedford afte r the performance

l<nights'Night

ROYAL GALA PERFORMANCE AT THE NEW LONDONTHEATRE IN AID OF ST . JOHN

(See At Random)

(Photos· SWAEBE 23 GrosvenorSt, WI

AT RANDOM (continued)

horror that 1 was no longer the holder of a valid nursing certificate.

But I reckon that if one really wants very much to do something, one can usually manage it somehow; and was delighted to find a ursing Division in London which kindly threw open its doors to two other male candidates besides myself at a nursing class on nine consecutive Monday evenings before Christmas, which 1 could attend without cancelling any important engagements. I admit it was sometimes a bit exhausting at the end of a busy day at Headquarters; and one evening I had to come up to London specially to attend the class after starting the day at a very early hour to fulfil a St. John engagement in quite another direction. But I'm thankful that I managed to keep it up, and still more thankful that I somehow managed to pass the exam, despite its happening to come at the fag-end of one of my busiest days in the I don't think that either the lecturer or the examiner or my fellow-candidates knew that I was already a member of the Brig ade, and I'm immensely grateful to the Division which welcomed me so hospitably and with such total absence of 'fuss'.

To all male Brigade members who hold a nursing certificate and 1 h ope th eir num bers will steadily increase - I most strongly r ecommend that they should not merely offer nursing as well as first aid in their re-examinations but also attend a full course of nursing lectures once every few years: but they should take warning from my mistake , and not let the validity of their nursing certificate expire before they get round to doing something about it.

AT THE THEATRE

The Roy al Gala Pr eview Per formance of Peter Ustinov 's play 'T he Unknown Soldier and his Wife' at the New London Theatre was a most delightfully memorable occasion - all the more so because it was graced by the presence of our Grand President , Her Roy al Highn ess The Princess Margaret. That this performance should have been so generously given in aid of the Order of St. John and its Foundations is a very high tribu te to the work of the 2

Order in the service of mankind , and every SIngle one oj us who in our various ways have a share in that work mU'it be profoundl) grateful to all the individuals and organisations who e hard work and generous support combined to bring about so outstandlngl) successful an evening.

Dr amatic criticism is not a regular feature of the St. Johr. Review , nor have I any expert qualification for offering il. BUI when such immen 'e care and pains had been taken to present performance for our special benefit, I feel it would show lack appreciation if one said nothing about the play It elf. For m)

own part, I found it a play which I am very glad indeed to

seen, not so much for its entertainment value as for the fact tha i it challenged me to think , and it somehow contrived to make thai often painful process positively enjoyable!

Though the opening sequences were perhaps a lilt Ie too druw n out, and the final sequence struck me with a sen e of anticlimax after the splendid scenes that had come Just before it, the pia) was so full of brilliant 'lightning touches ' (both 111 word and action) that it made me long for a chance to read the scnpt. 01 the pontifical and military qualities of Peter Ustinov and Brian Bedford in their entertaining series of atavistic roles it would bl impertinent for me to speak; but outstanding among other members of the cast were Tamara Ustinov as 'The Wife' (and her treatment of the [ am a book' speech was as fine a piece 01 dramatic artistry as one could wish to find anywhere), Tony Ja) as 'The Inv entor', Miles Anderson as 'The Unknown Soldier' (01 Miles Incognitu s'?) and Br ett Usher as 'The Rebel'

Now, having tried in all sincerity to express my personal reactions to the play, I hav e no doubt ensured that there will bl no risk of my ever being taken on as a dramatic critic! Be that al it may, I can only repeat on behalf of St. John Ambulance OUI most sincere thanks to all those who made the evening possible adding a special word of sympathy to Dame Margaret Wakehurst. who, having worked so splendidly as Chairman of Lhe Previe\\ Committee, had the misfortune to be laid up with flu on 'the night'

(L to R ) Lord Caccia, the Lord Prior Marjorie, Countess of Brecknock; The Earl of Snowdon; and Lady Caccia

Cadets being presented to Pr incess Margaret SJA's Grand Presid ent, by Lord Caccia

Spike Milligan, aided by his wife, arrived at the theatre feeling very sorry for himself

(R) Lady Moyra Browne, Superintendent-in-Chief, and Princess Helena Moutafian

in The Royal Exchange by the SJA City of London Centre dUring December. The exhibition, which covered all aspects of the work of the Order, was opened by the Lord Mayor of London (be low) a nd a former Miss World, Eva von Rueber Staier, of Austria (right, with a non St. John hair style), kindly modelled the new nursing member's anorak

The Disabled

HOW THE FACILITIES FOR SPORT AND LEISURE ACTIVITIES CAN HELP THEM

By Baroness Masham of Iiton

THE FIELD of the disabled is very wide and very varied. A Government suxyey of 1971 stated that there were over three million disabled living in the community. This is a larger number than the Government anticipated.

The disabled are on the increase, especially those disabled by injuries from accidents. I know perhaps more about spinal injuries than any other form of the disabled. But the spinal injuries are probably the ones most due to accidents and this can happen in many ways. I. myself, was picked up from the point-topain t racecourse by two St. John ambulancemen and I have never for one moment thought that my lesion is complete rather than incomplete because of the first aid rendered. It is important that first aid is correctly done when there is a spinal injury.

In my case we had done one round of the race when I fell. Before the horses came round again I had to be removed. I was unconscious at the time so I can never know if I was lifted in the correct way. But for any of you first-aiders, do be sure that you lift the casualty in the correct way because this can stop an incomplete lesion becoming complete.

Racing and riding are two ways of getting a spinal injury diving is another. These accidents are on the increase be ca use more young people have more money and more leisure time, being able to go climbing, racing, diving Divers very often div e through a wave and hit the sea bed; or they may dive into a river and hit a submerged rock. Other causes of spinal injuries are falling in a rugger scrum and being crushed by other players; fell climbing and falling from a height on to a precipice; gymnastics is another way. Bicycling, in which racing cyclists with their head down go straight into a stationary vehicle. Motor racing accidents often 4

This article was a talk gir en a t the S1.1 Vedical Conference 1972. Lady -'[a shalll is. of course, a member of the House of Lords: she is a member of the Central COllncil for th e Disabled alid th e l:.nglish Paraplegic Sports Association

result in spinal injuries for drivers.

It has alway amazed me how few bad ba ck or neck injuries there are from kiing. I was once on a skiing holiday when an Italian broke his back and his companions were plendid. I have never een first aid administered so quickly.

One took off his skis, struck the top off and used the ski to support the ca ualt) 's back. It is interesting that these different Injuries generally come in different sections of the spine.

Spinal injuries in racing and diving are generally in the thoracic region. I have known of at east 12 such accidents and they have all been of thi type. I , myself. have a complete lesion T-S Diving injuries are nearly always neck injuries. Rugger scrums generally cause neck injuries; falls from climbing are generally in the lumbar region, a also are mining injuries. In gymnastics, the neck is at ri k' motor raCll1g either neck or back and likewise skiing accidents , but more or less this is how it goes.

ow I think that another reason why these disabled people are on the lncrease is because of medical advancement in the treatment of high lesion, and they are now surviving where they used to die. I think it is an ethical duty of society, if such patients are kept alive, to give them a life worth living They want, and they can with the modern aids live useful lives; and they can have a certain amount of independence even if they are paralysed from the neck downwards. A very good slogan to show what rehabilitatiop means is: 'It is not what you have lost but what you have left that co unts '.

To illustrate thi I wtll tell YOLI abou a jockey. H e receIved spinal injurIes a a result of an accident and at first he did not \\ i h to liv e. It was through archer) that he realised he could compete in life and he took a courlic in accountancy, got ITI;]rried and started hi own practice. This t11ustrate ho\\ ports L'an help. The other phy ical side \\ hiL h haven't mentIOned if }OU have the top part of your hod), fult lise of hand and 3rm i (he necesslty to budd up the top p;]rt of the hody three tlmes as much, so as to compen');]te for not huYing the lo\\er part. 11 the-;e thing tuke a great amount of ph) iCed strength and, in fact. if )OU ha\e a fIt top pLlrt of)oLlr body you are better able to do this.

make the effort to find au t I,: here the swimming pool is, and it just needs a link to encourage them to carr) on or to pLl t them in tOllch with some place wllere they can go. \'[any do 110t want to as ociate them 'e lves with clubs for the dIsabled. Glasgow and edinburgh have excellent modern sport stadiums \\ here they have the right facilities for the disabled and they can go and com pete ;lnd train. In England there is the sport stadium at the toke Iand evi ll e Ho spital llnu they can go there and train.

Sport has been found to help tt di abled per on in social integrati o' There i a phy lCal and a p ychologi aspect. Ph yslcall}, ) ou ha\e to rega your bal,lTIce lost when you have ha pinal injurie I am ure all of you do n reali e that ) au c;]nnot feel ) oursl,'lf you have a complete lesion. Anyone \\ I a complete pinal lTIJUT) from that ;.m do\\ n lose the movement and the er ation, and the ensatlon is the mu: important part. When you are able-bodl you do not appreciate what an importJ pomt of balance) our 'behlI1d' IS. \\ h, you get into a \\ hedchJlr ::ifkr h3\' been lTI bed for a fe\\ \\ eek ) our b;]lan. is exceedingly ha) -wire , and the c[ culation ha to nght itself and thiwhere recreation help.

There are certain sports that particularly good for regaining balan. uch a fencing, table tennis and archer Al a from the phy ical side it 1 good getting the circu lation going. Parapleg Jre very :susceptIble to pressure sore. all of you well know, and this omething one has to live with. One h to work hard to ee one doe n't get the Then there the p ychologjcal set-L which [ think is perhaps more imporrJf' This i something that, \\ hen a person r had a bad accident and they reali e \\h they have done, they fir t have to accer and they will not progress until the) hJ accepted it. They must not look ba. except to recall the things that th enjoyed; they must l ook forward and II what they have left and make the best their lives. This is very difficult, espeCJ31 when they are active and virile you men. They sometimes feel they have be, a lmo st castrated and they need suppG nnd advice. Whey they find they c compete in sports they regain thelr Ie confidence and it gets them back 101 ociety and to competing In everyday I

In hospital it doesn't matter whether they are polio or PJ tic paraplegics the) generally have e\ er) thing geured for them. I feel there is a great lack of Illlk bet\\ een hospital and home and I think thi is where ou of t. J ohn \mbul unce can come in and help break the e barriers do\\' n. I feel it would be beneflCI;.]] if e\'ery hospital that had long ta). p;]tient had a ho tel \\ here they could graduate and get more lndependence But I think that port and going out to port meetings and going into pubs aften\ ards is helpful for integration. If patient just go home the) ometlIne lack confidence for going out and Il\mg norn1dlli\'e

There are man) ports \\ hich are done by paraplegics ; ureher), SWimming, table tenni. \\elght lifting, nooker, field ewnt : I have reservation , myself about puttlJ1g the shot. One has to look ahead and there can be Joint detenoration But thi is one of my personal thing ha\'ing had jomt trouble. In Y ork hire I kno\\ of J group of miner. and I find it importJnt that they get actlve bec.1U t' in lIch a cia 'e d community and recelVlng compensation as the) do, II 1 not \\ onl1\\ hile working, and if it \\ eft' not for ports they \\ auld detenorate rather quicl.d}. They have an archer) club, they pi;]), snooker and this keep them fit and giw them enJoymen t.

\\ ' lmming is one of the mo t benefiCIal ports. On the back no dlsableJ per on can ink, e\en If the\ are completely paral)ed from the the\ can float. You are \\clghtless in the When) ou're out of \\ ater \ au ha\ e no ldeJ how heavy the bod) Jnd if > ou are paraly cd from the \\ eli do\\ n \ 'o u huve to lift > all legs around and i't is terribly heavy going. Bu t in the \\ Jter the bo?> IS \\eightle sand ,0 )OLl get marl' rellef and a great amount of pkasure. Definitely Sports help to re tore and maintain to u maximum the phl' iCJI and ps),chologlcall'4 uil ibflllm Lmd I hope that ) au will be able to encourage disJbted people to take up port or to contll1l1e their port.

When the) arc in hospital tht'\ ure gcured up: eVer) thing is at hand: '\\hen the) go home sometimcs it lS dIfficult to

In other parts of the country, lIch as the '\'or th, the) have to make their own \\ a). ancl very often it is lack of u\\,areness of \\ hat is needed if they do not have these faCllitles. When I came to York hire \\oc \\ent s\\imming and before ver) long a ramp \\ as built to get us up the tair and we did not ask for it. ntil people know what i needed it is difficult for them to provide it. Better communication is needed.

A t Stoke Mandeville the sports stadium, which is divorced from the ho pital, runs games throughout the year for different forms of disabilitIes. Th ey have sports for disabled children and thi is becoming a popular event. nother ection of the disabled are spina bifida cases and many are paraplegics. The national games are held and from these the teams for the in terna tional games are chosen. Obviously one goes abroad. Th ese games are held all over the world and there lS great incentive to get into the international teams and this helps them keep up their sport. Certainly on the international side of sports, we as a nation pioneered it. Britain seems to be a great pioneering count ry and from this we find that other people do better what we have pioneered and this is ju t what has happened.

I have gone as a member with the international team to the games in R ome in 1960, to Australia, Japan, Jam aica and

Helping Hands

Martin Downey of Kentish Town, gets helping

Irene Humber (left)

Hampstead & Highgate Express)

Israel and it wa remarkable to see that the member of the British team had to cater for themselves, whereas other teams had their coache with them, helping their disa bled portsmen to be at the right time at the right place.

In the finals of one table tennis match my chair fell over and if it had not been for the companions of my opponent I would not have been able to get up and I would have lost the match.

The slogan of the paraplegic int ernational games is 'Unity , Friendship and Sportsmanship'. There is a great spirit within the games and we have seen how it has got better facilities for disabled people throughout the world , which was evident in Japan When we first went to J a pan there were no facilities for paraplegics there and they were very interested to see 29 countries represented from all over the world ; they took what was best from each country and by the time we left they had decided to build factories and hospitals for disabled people and now they have three factories whereas before they had none for their disabled.

Also at the international sports there is always a medical conference. Where there is advancement in the medical technique and treatment this is discussed, giving a chance for progress. There is always a need for research. One day we hope somebody will find a way of joining the spinal cord.

The financing of sport is up to the goodwill of the public and private enterprise. Some countries get help from their government Germany and Norway put their military airplanes at the disposal of the disabled bu t the British teams have to find their own means of transport. Sports facilities are progressing here but access is one of the main problems. Wherever you have steps you take away independence from disabled people but 1 think some progress here has been made in the last few years. Things are getting better, and there was an Act passed in 1970 whereby many sports buildings have to include facilities for the disabled It is easy to make laws and easy for them to be forgotten A swimming pool was being built in Scarborough last year with no access for the disabled. This was brought to the Council's notice and access was put in. But it is up to people who have an interest in the disabled, and those sitting on committees dealing with planning and welfare, to remind people about this access.

Very often it is simply things like access to the lavatory; the door may be too narrow, or it may open inwards, which is a great handicap.

Not everybody is keen or interested in competitive sports . Fishing can be very good and relaxing. ] is amazing in Yorkshire how popular fishing is and how many ex-miners fish and they have remarkably good fishing clubs. I have 6

always been ke en on fishing, and I h ave continued with my fishing, but do find that it is easier from a boat or a dinghy River banks or burn banks are h azardo u s because you suddenly realise a wheel of your chair h as gone down a hole. Th ere are wheelchair in process of being mad e that can go along the banks

Riding has become tremendously popular in the last years and this is being done by group. It has to be done locally because of the transport problems, particularly for c hildren One needs plenty of volunteer to pick them up a nd take them, to help them with their riding. This i a tremendously beneficial sport for spastics ann they find they can coordinate much better with their riding. They seem to concentrate on what they are doing because they are enjoying it.

I thought out a way of how to mount.

I got a pit dug so that the pony, a good and substan tial one used to carrying stags, walks down into the pit and is on the level of my wheel c hair. I take the arm off my chair and with help get on the saddle. Being a high lesion I have a built-up back on my saddle and this gives support.

Because there are so many disabiliti es different means of mounting are need ed; whereas the pit is good for some, other people mount from a mounting block or get lifted on; one needs variety and flexibility in all things. Riding is a sport that is greatly enjoyed by mentally as well as physically handicapped people , and the joy that saw on a small mongol boy's face as he stroked his pony is indescribable. These people like having contact with a living thing

If you have not got riding for the disabled in your particular area you can help stimulate interest. Hors e-minded people have not done much for the disabled but this they feel they can do and the local Fox Hunt is wonderful at raising money for this group.

Communi catio n is important One lady who has got herself organised with ponies and an indoor school and lots of helpers , and all the facilities needed, did not know where to get the children. It is putting people in touch with each other that needs improving. There is the new De partmen t 0 f the Social Services through which one can get in touch. J oint co-operation is needed on the part of voluntary and statutory bodies.

Another recreational activity is, of course, gardening. There are things lik e built-up beds , which people can have done and they can garden with a bed on the level of their chair. Strawberries can be grown in barrels or flowers in window boxes , which is so mething to be encouraged. It is important that people however disabled achieve something, and see what they have achieved. They get satisfaction and pleasure from it.

Gardening is something that people just don't think of doing for themselves ,

so a little stimu lati on helps. There nrc, 01 co ur se, aids [or g<Jrdening sllch as Ion! handled tools.

Th ere are oLher thing suc h as playinl bridg e, dart and stamp co lle cting whic can be introduced to people I think th a groups in schools arc splendid. We hav e disabled home in York hire and a loc, group comes up and plays with thelll There arc aids for people wi tho u movement in their arm and hands , SI that they can put up their cards whe they can be seen.

Oc c upation , essential for thl happiness of anybody. There arc peopl, who want to be pectators rather thai competitors and it is necessary that the' have factlitie at race meetings. i"ootba! and tennis matches Access again 1111 portant. Turnstiles bar wheelchairs: so b sure there is another entrance. Parking important. I know disabled people aI' g iven a yellow disc, but unless they hm help with parking thi i going to be problem of the future , They mllst b given preference They can get out of tt car for themselve bu t they can't gt near to the place where they wan t o hi

Di ab led people want help to be IT dependent; they don't want pity or t o patronised. Any per on in a volunt ar organisation must be ca reful that the don't patronise and do t oo much for th disabled. If you can do anythll1g abat encouraging local places of ment the cinema. concert halls, t o accer the d'isabled thIS would be helpful. Ther is a certain amount of discrimination an thi is unacceptable to anybod Rem ember the disabled person is person, and it IS not the vehicle th matters. Many people have looked at th wheelchair and remarked We can't ha that thing in here'. This has happened cases of spinal bifida and spastic childre can't stress the psychological dama r that thi causes. For instance. the Id e Home Exhibition does not allow disab lt people in at certain time. They say it h something to do with fire regulatio n This is somet hing people ought to loc into and talk about.

There is a tremendous amount progress in aids for the everely disabl which enables one to do different ( cupations, and there is now an ·A Centre' in K ensington with aids for t disabled and they have all informatIC about the aids which are on the mark and where they can get it. I is well war visiting.

There is an aid called 'Po sum'. Wit h the disabled can use an electric whe chair, turn page of a book, worh typewriter and answer the tcleph or Th ese are things which need to brought to the notice of some pe or who do not think they can do SU things. Introduc ed to these aids th becom e encouraged. And there is mu Some disabl ed people become treme dously good musici:1ns. 1 know a groUP

young men who arc very good at singing. [ know a young man who played the guitar cxtrcmc ly wcll. He used to shut himself up in his housc in the daytime and at nights hc would go off WIth his friends in his car Lo play his guitar uL a pub This is the <;ort of thing that you probably would be ablc to help. l:.ncourage him that h e an orcJlI1ary member of socicty and people won't oo k at him. That he is a person. If you can do this to these people who are not as well rehabilitated as others, you will be helping not only him but hi s family.

QUESTIONS AND ANSWERS

Q : Can any pressure be put on the British Railways Board to allow di abled passenge rs to travel In other than the guard's van.

A: On principle I would never travel in the guard's van. Di sabled passengers have to pay the price of the full ticket and they do not have the amenities in the brake van. The brake, of wheelchairs are not very strong and they can be thrown [rom one end of the compar tment to the othcr. The disabl e d also have to sign a slip saying they take this on their own re'>ponsibility when travelling.

New Competition?

During October amhulances from all parl:> of Hampshire converged on farnborough to compete for the Farnborollgh & Cove Ambulance Challenge Trophy presented to the winner of an clmbulancc drIving co mpetitIOn

This was an entirely new type o[ competition organised by the Farnborough Division with the object of testing the driving kill of the driver the fust aid knowledge of the attendant, and the team work of the crew. A crew consistmg of a driver and an attendant. 1t IS believed to be the f irst competition of this type to be held b) t John in Bntain.

Section 1 :

Ambulan ce und crew Inspecti o n The IJ1spection involved uniforms. first aid equipment. ambulance equipment. s tretcher gear, head lights, reClr lights etc., bells, two-tone horns blue li ohts etc. '''' ,

Section 2:

Attendant's !est. This was a diagnosis test. 4 pallents to diagnose. Time allowed per patient 2 minutes.

Q : You disabled. roughly disabled. said there were 3 million You seem to imply that 5% of people were severely

A The se are severely disabled people that are in some way badJy handicapped This Government survey only came out last year. This is a rough estimate. One of the clauses of lhe 1970 Act is that local authorities should find out the disabled people in their areas. This is difficult because some don t want to be known as dJsabJed. Bu t I think it is being got over to the disabled that if they will be registered then the facilities for them will becom e better.

Q : Could. you give a few details of the facilities for further educa tion for the physically disabled?

A : I think that integration is terribly im portan t and in clu bs such as you th clubs young people come together able-bodied and dis ab led and this is far better than having just disabled. They make friends. they can have places for holidays, and they enjoy the same sort of mu ic.

In Germany they have hostels for disabled children who come from all over Germany. The gymnasiums there have

hostels for the secondary, primary and grammar school children. All these children went to schools for able-bodied people. And r think this is something we should work at. In this way the ablebodied understand the needs of the disabled.

Q : Can the Authorities be pressed into providing public telephone kiosks to which the disabled can have access?

At the scene of the crew test n v 0 v ng an accident (Photo. Aldershot News)

Section 3: Driving Test. This wa a test plJnned by the local road safety officer. Drivers had to manoeuvre their ambulance through variou obstacle and were marked on their skill reversing and as e sing the width of their vehicle.

Section 4: Crew Test. An accident wa taaeo involving a car d riven by an who had knocked down a young girl. The crews were given the location of the accident and were told to treat <Ill injuries and prepare p:1tient / for a

A : Jf there were more public telephone kiosks that are accessible to the handicapped the Government would not receive so many requests from the disabled for a private telephone. r travel by train from Yorkshire to Kings Cross Station and the station there is without a telephone kiosk which is accessible by wheelchair. One day I had to make a 'phone ca ll and to do this I had to take the arm off my chair and unhook the receiver. When I had finished the call I experienced great difficulty in replacing the receiver and eventually I threw it back on the hook. A few weeks later I was again at the station and noticed that one of the doors of the telephone kiosk had been broken off and this made it much wider. When I commented on it to the porter he said sullenly, 'Vandals did it'. long journey. The judging included treatment, handling and loading patient s Into alllbuLlIlce. In JdditJon n member of the local police force \\Cl marking the po itioning of the ambulance on arrival at the scene Jnd the steps each crew took for their own afet) An intere ting point aro 'e in thi re pect. n:.lmel) that all ambulances were CClrr) ing tluore 'c ent jacket bu t not one crew u -ed them. The winning crew came froIll B:.lSlIlgsto\...e Ambulance Division driving a Daimler. Ru nners up were Lee-on- 'o lent Ambulance Division driving a \Iorris L. D Thi new competition i to become an annual event.

7

KIDNEY DONORS

Sir Keith Joseph, Secretary of State for Social Services, is endeavouring to enlist the goodwill of doctor and the public at large to encourage people to offer their kidneys for transplantation after death A card on which the bearer can declare his willingness for his kidneys to be transplanted after death is being distributed.

Latest figures show that there were 274 kidney transplants in Great Britain during 1970 and 351 in 1971. There are 15 designated renal transplantation units in England. At June 1972 there were 733 patients in England on home dialysis and 500 being maintained in hospital.

80 PLUS YEARS

The Priory Church in Clerkenwell has witnessed many unusual occasions, but perhaps one of the most unusual occurred there on ovem ber 16 1972.

Sitting side by side at an investi ture, waiting to receive the fifth Bar to their Service Medals , were Katie Pfister, present London District ursing Officer , and Dorothy Lee , a past London District Nursing Officer two nurses who between them have given over 80 years of devoted service to the Brigade and both eventually undertaking the e'Xacting task of London District ursing Officer.

[ t is on people like these tha t th e Brigade depends , not only for its teaching but for the splendid example of service to mankind that this kind of achievement shows. May they both go on to receive their sixth Bar.

CLIFF RESCUE

Following the report (Decem ber, Review) of a new cliff res c ue service at St. rves , Cornwall , set up by the St. lves Ambulance Division and the Coastguards, the first combined rescue took place on ew Year s Eve, when three young men were involved in an accident on the cliffs at Bosigran, about 8 miles west of st. [ves.

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST . JOH N

BY THE EDITOR

ASIAN REFUGEES

Headquarters: Mr. W Gebbie and Mr. W. Oliver, previously D evelopment officers, to Assistant Secretaries, A sociation.

Cornwa ll Major Magor to Chairman of Council, Dr. Towle, County Surgeon, resigned H ereford: Mr. J D. Pri ce to Dep. Com.

Norfo l k: Major . H. R. Glover to an Area Comm.

Notts: Mrs. Johnst one, ounty Supt. ( ), resigned.

Su sex: Miss (Dr.) Perkins to County Supt. (), vice Mrs. Hodges.

Wa r wicks: Sir David Wath er ton, KBE, CMG, to Chairman of the St. John Council. Mrs. L. R. Mitchell to County Supt ( ).

Within minut es of receiving the details of the accident, five members of the St.

Iv es Di VIsion were speeding to the seem with their equipment, covering the mile urney ovcr a vcry narrow and winding road in ubout 15 minutes. On :.Jrrival they were informed that one mi.ln had fallen about 300 feet into the <;ca Jnd wa still missing, a . econd was lying dcClu on a ledge a bou t I 00 fee above ea level and the third was stranded about hall· way up the cliff so badly shocked that he was unable to but uninjured.

The ambulance men and orne of the coastguard concentrated on this third man. mblilance Member Sam Vallel) secured himself to a afcty rope and then climbed down to the casualty. He then ecured the casualty to his own rope and aSSLSted him to cl'imb to the cliff top where he was examined and treated b) the other SJA members.

Meanwhile i:l helicopter, ummoned from R AS uldro e, recovered the bod) from the ledge and took It to the West Cornwall 11 0 pital at Penlance. \\ here the rescued man was abo taken for observa· tion and trcCltmcnl. During the whole operation the S1. [v es lifeboat stood-by a

DICK ARRIVES

short distance from the cliff.

The helicopter rc turned to the scene and with the lifeboat carried out an unsuccessful search for the missing man.

In charge of the ambulance team was Div Off. E. 1. Curnow, with Transport Officer P. Lander dflving the ambulance.

HOLIDAY HELP

Divisional Officer Keith Saunder, of orfolk, writes:

A Red Cross nursing officer and I have been bathing a Mr. Cook, a member of the Di abled Drivers AssoC1:.ltIOI1. for 4 years. Through him we met Mr. Charles Prudence, secretary of the orth London group, and were asked to go as helpers on a fortnight's holiday to Ibi za for 25 handicapped people of the organisation. We left Cai ler Holiday Camp, where we had been on night dut), at 4.30am to collect Mr. and Mr C00k from orwlch, and then on to Luton Airport to meet the rest of the party at 8.30. There were various degrees of disabled wi th us some mobile with help, others with sticks

or cru tches.

Charles Prudence managed to sort out boarding procedures and passports, and the luggage and wheelchairs were weighed in successfully.

With a lOam take-off, we waited in the airpo rt coach until 9.45 when we were to drive to the plane and emba rk but would the coach tart? No. It took 20 minutes to fll1d a fuel blockage,and it was quite a sight to see able and disabled alike clutching engine covers and spanner. under the driver's ord<,r<:1

With help from the Airport Fire Brigade, at last we got everybody aboard the plane: r h3d been so busy going up and down the steps that I had forgotten my nervousness about flying for the first

time! liowever, the flight presented no more problems, apart from a few of the party wanting to spend the odd penny, and we arrived in the sunshine of Ibiza two hours and ten minu tes later.

After a ten-minu te coach ride we arrived at the hotel at Cala d 'e n Bossa, with lunch at 2pm. There were about 600 people staying at the hotel and our small group of disabled people was made very welcome, with a champagne reception after lunch.

The weather for our fortnight in lbiza was generally good, alternating between very warm and very hot with a aay and a half of rain. We were able to get all of our party into the hotel pool at some time or ano ther. Mr. Cook had not been in a swimming pool since 1948.

The island, being only 26 miles by 9 miles, meant coac h excursions were limited. We went on a day tour of the island, which was most enjoyable but tiring, getting :25 handicapped on and off at about seven stopping places. One evening we visited a nightclub. and on another a barbecue.

One of our party, a 28-year-old spastic, soon became the idol of our hotel waitre ses with hi charm and laughter, and spent most evenings in the hotel's nightclub. At the end of the holiday he left the island with about 4 peseta to his name! An other, Earl. a negro paralysed on the left side after a stroke, was quite undaunted at the holiday-makers who asked him how he'd got hi tan so quickly!

All too soon we had to return: depcl rting in bright sunshine we arrived in England in a downpour. The holiday had been well orga ni 'ed and all one could q

wish fo r.

P rovi d ed the handicapped accept their dis a bili ties, t hey can, with he p, do most things t ha t the able-bodie d can do, and th e N o r th Lon d on group certainly proved tha t.

MED. CONF. 73

I h ea r that t h e programme is now comple t e f o r t h e 1973 Medical C()nference, a nd ex t reme ly interesting it looks too.

A par t from t h e Saturday symposia by the R oya l Air Force an d the B irmingham Acci d ent and R e h abili tation Centre, the S und ay programme includes the intrigu-

Herefo r d No. Nursing Division ce ebrated its 50th birthday on December 21 1972. The Division started with 15 members; today there are two nursing divisions, an ambulance division and three cadet divisions The photograph shows members and 'friends' mak ng an effort duri ng Wor d War 2.

ing heading 'What Price 1974?' when two gu est speakers, Mr. Anthony Carr, the Chief Nursing Officer of the ewcastle University H osp ita1 , will give his views of the re-organisation of the Health Service as it affects hospitals , while Miss Esme Few Director of Nursing Services, Bucks Council, will give the Local Authority viewpoint. No doubt sparks will fly

Two distinguished guest speakers have a lso promised to be present. The are P rofessor A lan Woodruff, the Director of the Schoo l of Hygiene and Tropical Medicine, who will speak on Travelling

and Hazards to Health', and to wind up Sir Derrick Dunlop wi ll present a lecture 'T h e Use and Abuse of Drugs by the Lay P ublic'.

All Brigade surgeons and nursing officers are invited to the conference. Application forms may be obtained from County Secretaries, or if in doubt you can always ring the Medi ca l Board Secretary Phil Adams at Headquarters he tries to be helpful.

NIGHT EXERCISE

SJA Berkshire is keen to involve their cadets and young adults in various outdoor activitie . They have had many training days , sports tournaments training camps, etc., and on Saturday November 25 held a night exercise on the Berkshire Downs This exercise involved an 18 mile walk and a short night bivvy

Everyone wore stout shoes or walking boots , warm and waterproof clothing, and carried a ruck ack co ntaining sleeping bag, bivvy bag , spare clothing, food, warm drink and first-aid kit , plus map, compass, whistle and torch.

The party was split into groups of three people who set off at 20 minute intervals from Compton, the first group leaving at 9pm.

Each group was given a rou tc card , which followed the course of the old Ridge Way Walk across the Berkshire Downs. They had a map reference as to where they would meet after about 12 miles of walking, then to sleep for tw o hours or so.

No r folk's Thorpe C ombined Division have launched a £5000 appeal to replace their headquarters (below), put up in 1947 Founded in 1940, (left) the first members had only AR P and Home Guard uniforms; membership, today at 35, is rising, T he Division's Treasurer is Mr. A Goodwin, 12 Harvey Cl ose, Thorpe St. A ndrew, Norwich

When the first group set off, in rain and strong wind on the exposed parts of the Ridgeway, it was not cold But by 1am the wind dropped. the skies cleared and the temperature was faning. By 4am the temperature had dropped to 29°F, but It did not remain cold for long, because when everyone awoke at 7.30 the air damp but the thermometer was at 36 F It was expected that each group would sleep for about two hours then continue their journey , bu t the maj ority must have enjoyed a comfortable night for many slept for 4% hours or more, which is unusual under bivvy conditions.

The following morning the groups continued, and when they arrived at Lambourn Memorial Hall members of the Lambourn Division had a hot breakfast ready for them.

Cadets and officers enjoyed the night exercise, and it is hoped to arrange a similar one this winter.

CAMP FIRST AID

During August 1972 the Sussex Scout and Guide movement was host to 800 Scouts and Guides from twelve countries at an internationa l camp he ld at the foot of the South Downs at Small Dole, neal Shoreham-by-Sea.

The orga nisers were deligh ted that Sussex St. John was prepared not only to undertake the responsibility for all the

first aid arrangements but also to camp with them.

The St. J ohn continP'cnt, numbering 8 members, including two cadets, slept under canvas. The major difficulty encountered was that the camp was divided into two parls, with the access to each field being some two miles apart. This caused a complete splitting up of resou rces, a nd also required the establishing of two first aid posts one tented the other a mobile caravan specially for this work and recently presented to the local division by the Henficld and District Round Table.

During the camp 184 patients were treated, suffering from 26 causes of accident and illness. Of these, 8 were transferred to hospital with a further 4 requiring the services of the loc a l doctor. In addition to these the occupants of a car involved in a road acciden t ou tside the camp were attended.

One amusing incident was the treating of a dog s paw. The dog protested most strongly, but no first-aider received any bitcs.

As would be imagined on a duty of this nature, certain minor language difficulties had to be overcome; but so adept were the members in this sphere that the Austrian Gir l Scout Group asked for a talk on basic camp first aid, which was

Canada , Cheshire and Sussex Competition

Started 4 years ago, this transAtlantic cadet competition attracted 19 divisions from the Hamilton area, Canada, Wallasey area, Cheshire, and Southwick, Sussex, in the 1972 event. The overall winner was 408 Bethesda (Canada) Nursing Cadet Division (above left) 2nd was Bebington (Cheshire) NurSing Cadet Division (a bove right), and 3rd was Steyning (Sussex) Ambulance Cadet team (right), receiving the shield from Area Commissioner D H F Burchell (Photo; Sussex Photo Agency)

given and proved to be a great success. The event also gave an opportunity for our members to discuss the differences and similarities between St. John work in this country and Germany, as one Scout was also a member of St. John in Germany

LOSSES

At the close of 1972 S1. John suffered the loss of a number of well-known personalities

On October 24, Captain Harold Pitcairn Hender son, R , CBE, DSO, Hampshire's Commissioner from 1964 to

1967, died. At Dunkirk and a destroyer captain during the last war, he was later aval Atta c he in Cairo, retiring from the avy in 1955. He joined St. John in 1958, and many will remember this jovial, well-over-6-feet in height commissioner, who, few realised, suffered acute arthritis in latter years. He became a Commander of the Order in 1963.

On ovember 29, Mrs Sarah Henderson, Assistant County Superintendent ( ) Berkshire, died after a hunting fall. She joined the S1. John Council for Berkshire in 1962, became Brigade County Vice-Presisdent in 1965, the first Area Superintendent for West Berkshire in ] 966, and Assistant County Superintendent in 1968 . Throughout this period she was a member of the St John Council appeal committee always ready with ideas for raising money. She and her husband, Major John Henderson, lent their house to St. John for conferences, their ground for training, sports and the Cadet 50th anniversary celebrations. Mrs Henderson was also fully involved in Ugandan Asian resettlement.

Publicity at the match SJA members took over the scorer's post for a fete at Aylesbury Town Cricket C ub last summer Worth trying at the next Test series?

(Photo: Maurice C ousins Aylesbury)

On December 28, 1r John Edwin Leo, founder chairman of the Civil Emergency ervice at Richmond, Surrey, died at the age of 56 He became active in Civil Defence during the Munich crisis in 1938, and when the Corp wa disbanded in 1967 he turned his attention to the role of the volunteer in emergency situations, and was a leading member of the ational Voluntary Civil Aid Services and an auxiliary of S t. John.

SJA's Civil Aviation Centre

TEACHES FIRST AID T O THE AIRLI NE S

By A. A W. Weston

THE CENTRE was formed in 1971 to provide airlines with the means of obtaining a uniform high standard of first aid instruction for both cabin and ground staff. Prior to this airlines would contact the local voluntary aid society (mostly St John) and according to the availability of instructors during the day and equipment, some form of instruction would be given. The training stewardess of an airline operating from 3 airports would find herself with staff trained to different standards by different organisations and over varying periods of time R'arely was the training tailored to the particular requirements of cabin staff.

Although it is obviously very desirable , there is no legislation which requires anyone aboard an aircraft to possess knowledge of first aid, but from the early days it has been the policy of British airlines that cabin staff should possess knowledge and preferably a certificate. According to the size of the company and the location of the airport, various methods of reaching this desirable arrangement were tried out. BEA/BOAC from the early days included first aid in cabin staff training and St John has always maintained very close ties with the Air Corporation's J oint Medical Service. Dr A. R. S. P effers wrote the St John Atte n dants' Handbook, while Dr F. S. Preston has been responsible for the training of St John Air Attendants for London District. Both are mem bers of the Order. While this happy state of affairs existed for the 'Giants' it was a different story for the smaller airlines who while insisting that the cabin staff had first aid knowledge, were not in the position to provide it, and many would-be stewardesses spent many anxious days trying to fi n d out how and where to obtain a certificate.

It was such a situation that sowed the first see d of the Centre in 1964. A group of stewardesses of British Eagle at H eathrow wrote to Headquarters, Grosvenor Crescent, and asked what cou l d be done. Col. Gueritz asked me, and as a result what could well be the first St John course for cabin staff was 12

organised. Training took place in the flat of the group of stewardesses on Sunday mornings. To say that it was an unusual situation was putting it mildly, as on occasions girls returning from night flight s were wanting to sleep, and on another everything stopped while one of the girls took a phone call from a boy friend in New York. For this first course the girls had to provide the accommodation , t rain in their own time and at their own expense.

The value of this course tailored for cab in staff was recognised by British Eagle, who from then onwards took responsibility for the courses and all ca bin s taff were trained to certificate standard. Th e man mainly responsible was Mr K Ford, the Company's Cabin Servi ces Sup eri nt endent, and 462 cabin staff obtained cer t ificates. Wi th the closing down of Briti sh Eagle its staff dispersed to different companies at various airports an d it was not long before requests came from Luton Gatwick and Stansted for similar training to be mad e available.

It was these requests that led to the idea of forming a Centre, and I was asked

if I would consider organi ing it. Thc Centre would be concerned within the industry in providing training for: I, all Cabin Staff, and 2, all Ground Staff.

The centre would be unique in that, unlike other speci<ll centres within a particular industry, Rallways, Post Office. Do cks, etc. which have paid staff, accommodatlOn, and equipment provided, and all the courses are run within the industry, it had no accommodation, no money, no equipment and no captive classes. The Civil Avia tion Centre was to be a. group of volunteers who would have to sell a service (to teach first aid) at a fcc high enough to make a profit with which to pay lecturers and instructors, buy equipment, hire accommodation, and put a bit by for the obtaining of its own headquarters.

This was Indeed a challenge. 1 d IScussed it with those who had assisted me over the years at Heathrow Dr Melottc, Mr Storer and Mrs Kirwin, and 1t wa decided to accept the challenge.

The inaugural meeting was held in J anuary 1971. Joining us on the com· mittee was Mr K Ford, now Cabin

Services Superintendent with Monarch airl in e at Luton to advise us on the requirements of airlines, and Mr J T. Skipper HM Inspector of Factories co ncern ed with Heathrow, from whom we hoped to learn of an overwhelming need for first aiders at airports.

What we did, in fact, learn was that (a) there was a real need by the independen t air[jnes for the service that we had to offer, (b) th at the biggest potential customers were not Interested, as St John hlld not been ab le to provide the service they required In the past and they had made alternative arrangements. and (c) that the requirement for first aiders at Heathrow was very mall indeed, despite 50,000 people working there. BEA, BOAC and Briti sh Airports Authority had Medical Centres and were granted exemption, and that, to crown the lot, British Airports Authority ran their own training programme and be ides training their own personnel took on anyone from companies within the airport perimeter. St John had virtually lost H eathrow.

Despite this gloomy outlook it was decided to go ahead, d ecidi ng tha t 'If the artic le (first aid training) is good enough it will sell Itself', and we decided to offer what we thought would be as high a standard of instruction as anywhere in the country and tha t eventually the companies would come to us. (Wishful )

The plan was to devote our first six months to the training of cabin staff at Luton, Gatwick, Stansted and Manches ter, and then tackle the ground staff at Heathrow, if we could find a way in.

Starting with a loan of £.25 from HQ, and equipment hired or borrowed we ran 21 courses in the period up to and with the profit started to buy our' own films, for we had proved to our satisfaction that good visual aids films film loops and sl ides backed by' lecturers and instructors were paying off.

From the beginning we presented ourselves to civil aviation not as a bunch of do-gooders offering to teach first aid free bu t as an t teaching uni t equ1pment and tailoring the first ald. to requirements of their industry. This serVlce was available to them at a realistic price and not once did that deter them. We gave them the service we promised and they came back for more With the success of cabin staff training

Our belts, we decided to tack l e the blg task of winning back Heathrow for St John and pu tting first aid training on a new higher level. We sent over 100 letter to c.ompanies, mostly in the Cargo Termmus , which was the only uncommItted We got 8 on the cour e. It was a fmancial fai lure, as it costs about £ 150 to run an intensive industrial course, but it did what we intended it to do. It showed Heathrow what we had to offer. Shortly afterwards I had a V1Slt from the Training Officer of British

Airports Authority, Miss Hazel Webb, to discuss the possibility of our taking over the training of BAA personnel. This was ater agreed, and Miss Webb joined us on the committee. This was followed by a request for the training of BEA and BOAC ground staff, and after a meeting with mem bers of the Air Corporations

Join t Medical Services, the Senior Industrial M.O., Dr 1. Dawson, came onto the committee.

ow we cou ld say that we had become established as the centre for first aid training at Heathrow

This was followed by a request from BAA at Gatwick to run an intensive course for them, and with the help of the SJ A Horley Division this we did. Wherever we operate we have to hire accommodation, and naturally our first choice is the local St J ohn HQ. This is a useful boost for Divisional funds. The same applies to extra instructors and examiners. We hope that by working with us, using visual aids, this broadens their outlook on the subject of industrial first aid and instruction in general. I n fact, we know this to be the case.

Where does the Centre go from here?

There are still airlines which we would like to work for in one capacity or another, bu t before tackling them we need more suitable instructors and equipment, so that we can ensure the same standard of instruction.

Can we improve our service? Certainly, by having our own Centre HQ in the vicinity of Heathrow. A building, purpose-designed for teaching, with adequate black-out, heating and toilet

facilities things which the st ud ent takes for granted at his works yet is so sad ly lacking in many St J oh HQ s up and down the coun t ry. Fortunately Lut on and Gatwick have fine modern bui ldin gs. One may ask 'Who's going to pay for your HQ?' It is our intention that it will be the avia bon indust ry through the courses. We are convinced that if the article is good enough it will sell itself, and if we continue to produce a good article we are convinced that it will se ll and the profits will be ploughed back to provi d e a very efficient service.

Of course none of this will be possible without the help of our colleagues at Grosvenor Crescent HQ , at Feltham, Luton, Gatwick, Stansted, Manchester and D erby, who backed us to the full from the begin n ing and I am certain will continue to do so.

With such a high standar d of instruction, it must surprise people to know that we have the highest failure rate of any Centre. This is one of our strongest selling points, for we have set a very high standard for the examination and failure to reach it has but one result, which is not very popular with the stu d ent but the air lin es know that we have a definite standard and we are not prepared to lower it just to please everyone. We agree to take the student back on the next course at no extra charge, but we will not lower our standards. If the student works hard enough with us he can obtain a certificate, but it is made quite clear to the companies that the payment of a fee does not m ean auto m atic issue of the ce rti fica teo

At the recent Presidents' conference held in orfolk a new mobile first aid unit was dedicated and named 'The Desmond Buxton Mobile First Aid Unit', in gratitude to Mr. De mond Bu x ton the County Treasurer, for his work' and genero ity to the Brigade in orfo lk

The unit, a Commer van fitted out with all requirement for fir t aid duties,

is light and easy to drive , and can also be used to take personnel to their various duties when necessary.

Insp ecting the unit are (l to r) Th e Countess of Br ecknoc k Mr. D esmon d Buxton , S ir I vison Macadam, County Pr esident, Bri gadier Pet er Barclay, County Commi sioner, and Mrs. De smond Bux ton.

The Civil Aviation Centre's committee members (L to R) Mr A. A. W. Weston Sec; Mrs. D. J. Kirwin, Treas; Mr. G. Storer; Dr. G Melotte , chai man ( P hoto: G. F Hollings)

The Old World

Part three (final): Damascus

THE 1972 SJA TOUR TO RHODES, CYPRUS, BEIRUT AND DAMASCUS

by Joyce Hamilton

FROM BAALBECK we travelled by coach to Damascus , which is alleged to be the original garden of Eden and where Cain slew Abel. On the way we marvelled at the profusion of wild flow ers growing in the valley of the Barada Riv e r th e Abana of the Bible Orchards of apricot, walnut and olive trees held back the d ese rt and beyond groves of poplar trees stretched into the last foothills of Lebanon Anchusa, dog roses, wild achilea and the purpl e heads of massed thistl e grew along the roadside leading to the oasis that is Damascus , the paradise of

Mrs. Joyce H amilton was in the party of 20 people who went on the 1972 St. John Tour of the Eastern Mediterranean, which was led by Headquarters Registrar George Woodhill. Mr. Woodhill will be leading another 15- day tour, visiting Rome and srael, from September 15 to 29 1973, which is not yet fully booked

the K oran, and the city which once belonged to Zeus.

Our guide, a sad, good-looking Pal estinian who had served in the Pal estinian' Poli ce, joined us on the first

evening of our arrival in Damascus, telli ng us something of Seidnaya and Maloul a where we were to go the following da)

The road to Seidnaya was steep and deserted; the mountains of lIelbon grim and forbidding The convent of Seidnay stands on a citadel of black rock over· looking the village, which is white wJt h churches. Tombs and chapel have bee n carved into the mountainside. It is Said that the convent was built where oah planted his first vine The Byzantine account of Seidnaya dates from 547AD during the Persian wars The Emperor Ju stinian was seeking wat e r for his sol d iers who were encamped near Damascus, when he sighted a deer. Hr pursued it to the summit of a great rock, but when he drew his bow, he was startled by a torrent of light. The de er had changed to a woman clothed in white. She told him to build a church and convent on the rock So Justinian built the convent and installed his sister as the first Mother Superior

Clim bi ng a steep zig-zag of steps fronl the village, we entered a small cool courtyard where a black robed nun, with a gentle, serious f:lce, motioned liS intc the mother superior's apartment. The Mother Superior, speaking in French en tertained us a nd proud ly showed liS samp es of needlework and other craW

made be some of the fifty orphans at the conve nt school. The room was bright with gaily-coloured co tton chair covers, a foot-stool to ma tch, cheerful orien tal rugs on the tiled floor, the walls covered with large photographs of previous Mother Superior and Greek Orthodox pnests. There were also rather garish paintings of the V irgin and Child, and one rather lovely one of th e head of Christ.

We were served with small cups of black Syrian coffee and sweets from a large round tin. The nuns wore black ca lico robes with no softening frame of white to relieve the sallowness of their complexions. Their coifs were so tight fitting that one assumed that their heads were shorn. In the small courtyards they flitted to and fro across flagstones pitted by many a pious foot.

A strong incense pervaded the high domed church and in the strange atmosphere of devotion and garish artistry only the delicate wrought iron veranda , encircling the upper walls of the dome really pleased the eye. There were many huge tawdry chandeliers of glass and brass, with large coloured glass balls suspen ded from their bases and paintings of saints and the Virgin and Child with vacant expressions and ungainly postures.

We were ushered into the hushed sacristry, half lit by cand le light and lined with faded Byzantine icons. Offerings of jewels and gold models clustered the lower part of the wall beneath silver doors. Behind these doors lies the silver cask containing the first picture of the Virgin and Child painted by St Luke the Evangelist.

This is the treasure of the convent.

Once its Virgin wept and the Knight s Templar sent back the tears to Europe to cure ophthalmia and sterility.

We emerged from the coolness and peace of the convent, shadowed in its ancient past , into the hot sun beating down angrily upon the exposed white village below

We drove to Maloula along a road skirting the Shurabin mountain. To the west , mile after mile of indomitable rock forms a formidable barrier across the lower slopes of the Lebanon, holding back desert and invaders. We came to a small oasis of walnu t trees and mulberry bushes, with sheer crags rising behind them. The houses were built high into the rocks, some of them from the grottoes , engraved from ancient times with Greek writings. St Tekla built a monastery here considered to be the oldest in the world.

Only the foundations remains, and upon them stands a modern church. The Malouleen legend says that St Tekla, who had sat a t the feet of S t Pa ul, was fleeing from her pagan father when she foun d herself t ra p ped before the solid mountain. She prayed so ardently for safety that the cliffs split apart and let her through. The saint is buried in a tiny chapel in a cave above. Christians and Moslems alike come to take away the sacred wa ter tha t drips from the ceiling. The people of the village of Maloula are the last on earth to speak Aramaic, the language of Christ.

Moslem tourists joined us, climbing to the cave above. The men wore the black shaggy trousers, called Cheroual, tight at the leg and baggy at the crutch; so designed, it is said, because the Moslem's messiah shall be born of man. The women wore gay cotton trousers with little frills at the bottom, and over them a coloured sari, folded and gracefully draped, and also covering the head. Passing through the village we heard the call from the mineret of the mosque and saw the villagers hurrying towards it. Moslems are called to prayer five times a day. We were there on a Friday, their Sabbath. Tables covered with white

ST. JOHN AMBULANCE TOUR SEPT. 1973

Rome: Sept 15th, 16th, 17th including a visit to THE VATICAN

Jerusalem: 18th -26th. Pater Noster Church Gethsemane, the Spring of G ihon Bethlehem, Shepherds Fields, and ST. JOHN OPHTHALMIC HOSPITAL Mt. Calvary, Church of the Holy Sepulchre.

The 1973 SJA tour next September will include a visit to the 5t John Ophthalmic, Jerusalem

Led by Mr. G Woodhill

cloths stood in the courtyard of the mosque. A communal meal was b e ing cooked in the roadway by the side of a stream, which ran through the broad street of the village. Buxom , open faced women stoked the wood fires beneath two large black cauldrons filled with a strange white liquid afloat with vegetables.

From the village we climbed to th e monastery of St Sarkiss , wher e a f e w Greek Catholic priests live with their cellar full of home-fermented wine. We did not go into the monast ery but climbed to the top of the mountain where a flag of Syria waved in a r e fr es hingly cool breeze. There was a cave where cool drinks were sold. Here inside th e cave, a king once held court and would perform a marriage ceremony if th e man could prove that he owned a home. Now drinks were sold there

Later , in the coach, our guide point e d out a large opening in the rocks far a bove the ground. In days of old, women and children would hide there from the enemy , possibly for months on end, for there was a spring inside the cave.

We looked down from the height s into the gorge containing the village of Malou\a , unchanged in the last two thousand years.

On the way back to Damascus , w e saw a herd of camels with one baby came l.

The Syrian herdsman , when he saw our coach had stopped for our photographers brought a camel up the slope. The r el uctant beast snorted angrily and appeared very mangy at close quarters. The herdsman looked at the bp offered him with utter contempt, but took it graspingly.

The next day we were to learn something of Damascus itself. The Damas cenes remember Walid as the builder of th eir great mosque , classified by the Moslems , after Mecca , Medinah , and the Dome of the Rock, as the holiest place on earth. Walid destroyed the Christian c hurch of St John, which was in the square, a nd today only the Roman walls of the original temple of Jupiter remain. On th e site, th e mosque was built with Christian labour helped by Egyptian artisans. It is a miracle of architecture The towers were the first minerets of Islam and from th e m the early muezzins shouted into the dawn ; now the call to prayer is prerecorded on tape. To the south east of the mosque is the tower of Jesu s, with its slender grace from its summit Christ will descend on the Last Day dispen si ng judgement (say pious Moslems) To the west is the Egyptian mineret, and from the north wall rises the Miner e t of th e Bride, the loveliest and oldest of them all.

In the large reception room we were asked to remove our shoes and black cloaks were placed over our shoulders, to hide our beauty our guide informed us Beautiful hand-writt e n copies 01' the Koran were displayed in glass cases. On e, copied by a Turkish sultan, was 750 years

16

A d o ubl e arca d e of co l umns ncccntua tes the length of the prayer h nll , whi ch s tret c h es a l ong the o uth wall of th e cou rty ard. Luxuri ous c h andeliers hang in a tripl e row, beau tiful and sophisticated against the gnrish blue of the roof. Orie ntal rugs are ewn togeth e r to keep them intact. Th ey were of a ll sizes and co lours donat ed by wealthy Moslems, and every two years they are cleaned and taken out to h ang in the courtyard. A c l ea n er was sweeping the carpets with a huge palm l eaf. In the co urtyard is a treas ur e d ome where the w ealt h of the mosque was kept under lock and key. Fine mosaic work decorates th e arches and walls of the mosque, and the mosaici sts' work is never ending. They are now coveri n g th e transept wa ll with designs reconstructed from 8th cen tury remn a nt s of the west portico.

In the sanctuary is a domed mausoleum containing the head of J ohn the Ba ptist. H erod sent the head to D amascus so that R oman soldiers could b ear witness to the execution.

Our guide told us that when Mah ommet went to battle he took with him his shroud, which he wound around his head in the form ot a headdres so th a t if he was kill e d he could be wrapped in it; this became a traditionn l headdress for Moslems

We walked from the mosqu e to the Azem Pal ace, partially destroyed by a m o b in 1926. It was built in 1750 and has three sections, the harem , the guest secti on a nd the servants quarters Th ey surround a peaceful courtyard where h o ll yhocks grow beside a goldfish pond.

The architec tur e of the Turkish hom es is a ll the same; the richer the occupan t the larg er the home. A folklore museum occupies the guest section. Th e ce ilings a r e ornate with bea ut iful carvings and in one room is a scene showing Mosl ems in Mecca, robed in white with one shoulder free. Ri ch and poor dress so, for in Mecca a ll men are equal.

We went to the street called Straight.

Origin a ll y, in the time of the Roman s, it was 75 feet wide, but our bus just manag ed to squeeze along the n ow n arrow busy thoroughfare. At the far easte rn end of th e street we arrived a t th e so l e survivor of the seven grea t Rom a n gates of Dam ascus the Gate of the Sun.

On e co uld imagin e the co l ourfu p eacockworld of those times , when Ju piter's templ e s t ood there in all its gl ory, a nd h orses, drawing chariots, cantered down the great columated street, which was fl a nk e d by theatre and governor's palac e.

It was t o Juda s's house in this street that Paul ca m e when he was struck blind on the way t o Damascus. Then the Lord s pok e to a di sc ipl e in Dam ascus named

An a nia s.

'Go int o the street which is ca ll ed Straight a nd enq uire in the house of Judas for one ca ll e d Sau1.'

So AnLlnias went and laying his hand s on Sau re sto red his sight. The hous e of Judas no longer exists but we visited the a ll eged house 01 Anania where we were tak en 15 feet down a stairway to the leve l of a Rom an street; here, there a small chape with rough stone wall a nd ceilings, and a fell pews. Thi is the on ly early church o survive in the city. It was turn ed into a mosqu e by aladin and recent excava· tions (in 1921) revealed a classical temple with an altar dedi cated to Jupite r.

Aft er seve ral years or preaching in Arabia, t Paul returned to Damascu s.

The Jew s picketed the gates hOplOg to kil l him, but at night the disciples lowered him d own th e city wall in a basket. An earh church was built near the Ka ysan where hristians believed the descent wal mnde. A mosque was built over it whi ch has since disintegrat ed. Today the Gate il a hands ome Ottoman structure. Beneath its arch the Greek Catholics have built shrine to t Paul. In the Chnsttar cemetery lies the tomb of St George whom the Damascenes ay was ar, Abyssinian Chri tian porter guarding th Kay san Gate. It was he who allowed SI Paul to escape. Ili s tomb became a of piLgrimage for centur i es. Our St Georgi was a Roman oldier martyred h. Di oc\et i an and buried at Lydda. Bot saints appenr to have lain dragons.

[n the street called Straight we we', taken to shop displaying silk and bm) gold and copper, ironwork, carpets ane eonfectionary In the street J man poureL liqu orice drinks from a long glass spou' attached to a si lver con tain er trapped tl his body. lie dispensed drinks With swinging grace of hips and hands. In tit: shops, coo l free drink were thrust befor, us and Ollr eyes feasted 011 crystallint fruit soaked deep In sugar sligarr' almonds, Turkish delight, paniers shelled walnut and sacks of dne, apncots, brocade SIlks tumblIng alan! counters, turquoise studded braceleb rings of A lexandrite, agate and aqu marine, nnd orienta l carpets of description. In Damascu s gold is chear but the grace of antique glass and coppr work contrasted adly with toda) degenerate artistry.

Earlier, our Beirut guide had bee: startled when we t o ld her th"'t we woul , be in Damasc us for three days.

' What on earth will you do ?' sh; asked. 'llalf a day is enough o s(': Damas cus"

Three days were certain ly III enough. We were then only ju t begi n ning to get the feel of the place. At fir the noise and th e heat w e re di st urbing , it true; but gradua ll y the atmosphere oj th city's ancient past seeps through and ani wants to remain or return as soon 3' possible. As I'm sure tho e on the 191 SJA tour will feel about their visits I( Rome , Jerllsalem and Tiberia s.

NEW BOOKS

MEDICAL ASPECTS OF HOME HAZARDS.

Editor: Ala sta ir N e lso n M edi ca l Commi ss ion on Ac c id e nt Pr eve ntion , 50 Old Brompton Rd, London , SW7 3EA. Pric e SOp

Member s of Sl. J o hn Ambulance hardly need reminding that about one in three of a ll fatal accidents tak es place in the home, and that 'acc ident s' do not happen they arc caused. Of these fatal accidents about one in ten occurs below the age of five and nearl y two third above th e age of six ty.

These arc sta rk figures their content of human misery is almost incalculable. And they arc preventable. St. ] ohn is becoming more and more active In the field of education and preven lion, and it would be nice if we were so successful that we cou ld work the first-aiders out of <J job. This happy state of affair, though. is a long way off, and we are in constant need of really good educational and propaganda material. I his the booklet under review provides in very full measure. It covers a WIde field, [rom the battered baby to the burnt dotard, and a mere list of the contents would be unhelpful. My best advice J for every Division to buy a copy, and make slife that it is circu lated and widely read.

Robert Ollerenshaw, Surgeon-in-Chief

NURSING IN DEPTH SERI ES:

General Care of the Surgical Patient

b y. Joan Borland Butt e rworth 4Sp each ThJS smn ]] book opens with a brief of surgery and patient care nnd IIl c udcs a useful sec ti o n on surgical termIno logy which students new to surgica l wards often fi nd rather confu ing. The pre- and post-operative care of the patient is clearly exp lained and reasons are. given for the various procedures wh Ich are carried out.

a Th e types of wound drainage re well des c nbcd and the im portant pOInts 10 the ca r e or wounds arc simp ly su mmaris e d.

section dealing with the psychol ogIca l approach shows a gC;luine or the patient's and 1 characterised by sensible advice on how to help them with their varied problem. ]" :he chnp ter on CO I11P Ica tlOn s is very co mprehensive and nurses working on surgica l wards would benefJt by st ud ying it.

Alth0.ugh detailed , the whole book is wntten 10 a simp le style with the minImum of techni ca l jargo n and would be SUitable not only for tud ent and pupil

nurses but also tor nursing auxiliaries.

Lumbar Puncture and Related Tests

b y U Joll y.

An exce ll ent anJ convenient book which really docs des c ribe in depth lumbar puncture and similar procedures. The relevant anatomy and phYSiology is Simply bu t very c learly described in the first chapter and the accompanying diagrams are extremely good, especially those illustrating the blood supply of the bral11.

The preparation and after-care of the patient in each case is most meticulously exp lain ed, as well as the observations necessary during the actual procedure and what the nurse can do to asslst the doctor.

The indications and contra-lI1dications for each procedure are su mmarised and the general la y-out of the book makes it easy to study.

It would be a most useful reference book on wards or depnrtments where Lumbar Puncture and similar precedurt.'s arc lik ely to he performed and It would also be of great aSslstance to tutors teaching the theory of thee procedures In schoo ls of nursing

Nursing the Diabetic Patient by Eric Edmondson

A very well-thought book. written by d nurse who IS also a diabetic and who is therefore v"ell dware of the importance of maintaining the necessary balance The condi tion i simply and clearly expla in ed: and the nurse's role, both in caring for

Leicester Moat Road nursing cadets Jasu Pat el and ChristIne Bonner on one of their Div Ision s dutiesat the Lei ceste General hos pital's school for han dcapped chi drcn (Photo: Peter J ackson)

the diabetic pattent and In educating him on how to cope with his diabetes , is stressed.

Pr obably be cause of the authors personal involvement, there IS a most welcome attitllde of co mmon sense and realism regarding diets and the problems of daily living The check list of questions on pages 25, 26 and 27 is an excellent way of making sure that the theory and practice studied has been fully understood and CLln be ea rned out efficiently.

This would be a most use[ul and hLlndy reference book to keep on a medical ward where diabetics are being nursed.

K.M P.

THE TRAVELLER'S HEALTH GUIDE

by Dr A C. Turner

Tom Stacey Ltd 7Sp

This is the kind of hook that having consulted it for the first time one wonders how one ever fared without it.

Primarily it was v"ritten as a guide for air travellers htl t travell e r abroad by any mode of transport \vould do well to studv It before departure. -

The advice given on clothes to \\-ear. food diseases prevalent in different parts of the world, climate, immuOlsation and many other relevant ubJccts is presented in a straight forward, readable st\ Ie and each chapter includes a line -illustratlOn relating to its contents: these have a subtle humour of their own with a definite teaching \Jlue.

This book is recommended to all traveller abroad and certainly doctors called upon to advise tho c venturing abroad would find it a most lIseful reference.

Voluntary workers doing escort Juties abroad come into the ame ca tegor). The present wntcr ha found it a most helpful manLial and would not be without it J. S. Binning

CONFLICTING?

from Mrs. P C. Park er, Divisional Superintendent I have just seen the new publication First teps in First A id and think it i an excellent teaching book by which even some adults could benefit l

Having learnt continually from its page. OT to give a casualty food or drink, 1 passed on to the new cssentlab of First Aid and on page 10 I awa picture of a young lad with right arm in a large arm sling being offered a cup of tea. How are our young people expected to act when they come acro s two conflicting views like this? For my part I shall put a cross right through the picture.

Kent.

The Association Secretary replies : P. C. ParAeI'

The Chief Medical Officer has asked me to point out that the publication First Steps in First Aid was designed for the 8 to 11 age group of the school population, following the advice of the Department of Education and Science that first aid teaching in chools should be geared directly to the level of responsibility which could normally be expected from the group addres .e d. For such young students it is inadvisable to introduce qualifications and exceptions. The teaching, therefore. is more dogmatic than is neces ary for older groups.

The E sentials of First Aid is designed for persons of any age group seeking a first introduction to first aid and extending a far as the statutory standing certificate, for such candidates it is perfectly possible to introduce exceptions and this is the reason for the discrepancy noted by Mrs. Parker which is more apparent than real.

HOLIDAY DUTY

from P. Bunch , PRO My wife (a nursing member) and I applied for and received a holiday duty in Cornwall for two weeks during August as guest of the SL Miniver Division.

During the over-night journey by car with our two children we wondered what we had let our elves in for, but on arriva l our doubts were dispelled. We were welcomed by the Divisional Superintendent and Mrs. Theo Strout, loaned a caravan by 1I-s. Jerram, and helped no end by Mrs. Cobb ledick, Div. Supt.

The duty covered was the Oakley Beach Hut, at Pol zeath. which was presented to the Division in 1957 by their Pr esident, Mrs. v. W Oakley.

The hut contains a small bed and is fully equipped to deal with any emergency from a simple beach mishap to a serious occident. E l ectricity is laid on, and water to a small hand basin. I t is possible for a doctor to do minor surgery in the hut, as happened prior to our stay. A eil Robertson stretcher is also kept in case of cliff accidents. as a close liai on exists bctween the Division and the local cliff rescue team.

During a busy season as much as 850 to 900 hours duty IS recorded, and an average of 470 cases are treated. The success of the duty is also due to other local Divisions and the British Red Cross , who work in harmony with the St. John.

The ursing Cadet Division, olthough sma ll, is quite active, and three of the ex-cadets are now fully qualified nurses.

Should other members feel ILke applying for the duty, we can say you are certainly made to fee quite at home in CornwalL London, N.8. P. BUl1ch

from W. E. Street, Divisional Officer

I quite agree with R. Gibson's letter (November R eview) re the closed St. J ohn first-aid posts to be found during the summer month s and also that It is a problem. But surdy this is where our older members co uld be used, as women are pensioned at 60 and men at 65? At that age hey are still more than capob le of manning a first-aid post. This was indeed started at Exmouth two years ago and has been quite a success.

Our first-aid post is manned jointly with the locol R ed Cross, 18

READERS VIEWS

Readers' views and opinions, which should be sent to the Edit or although published are not necessarily endorsed by the EditO r[ the Order of St John and ItS Foundations A though readers rT'; sign plJbllshed letters With a pen name writers must supply the name and address to the editor

and for }ears has been open ever} afternoon during the Scil( holidays, and at mid-week and weekends from Whitsun un mid-September. But now with the help of some of OUI old members the post is ope:l all dJy for the summer season of: week,

Through this we do, as Mr. Gibson 'iuggests, make contact \\1' members from other towns. and over 1 cuppa ha\e qUIte and interesting chats.

I personally met members of St. John last summer from, Blazey (Cornw ctlll. ewbury and Watford, JS well as peor interested 111 fir"t-aid fr0111 AU'itralia, l11erica. Canada, rrJ and Germany. I directed these vi"itors on to our headquar tt where they could meet some of our full time staff and look 0\ our ambulance station.

If we do thiS, I am sure other divisions can Give it a try.

Exmollth rt'. E. Srr

from Mi s L. Harris, Divisional Superintendent

In reply to R Gibson's letter ( ovember ReView) on the subJt of duty at holiday resorts, I must point out thot for the pJst years Birmingham has held a annllol county camp at ma' holiday places, and while at camp we have helped out III Ola: types of duty

To name three, in 1966, camring at Grange-over- ands. received a call for help from 0 holiday home for hondlcap P' people to take them on a shopping spree around the town 1\13 of these people had not been inside a shop for years

At C1evedon, Somerset, In 1967 we covered first aid duty at two-day gymkhana, for which the county oltlcer was v..:ry grate!.

Only thiS year at Swanage, Dorset, eight of our adult and cad. campers covered two afternoons on beach-hut duty.

Our ci ty members enjoyed dOing these duties because the were different types to which they are accllstomed

So t o the question 'Is thi s a practical proposition'?' most us in Birmingham say: 'It is.'

Birmingham

PROFESSIOrJAL BADGE

from David Lee, Divi siona l Officer r ngree wholehearted y w,ith the of .M. V MOring (November Review) regarding recognltlOn of full time amhulance personnel.

I have been a full time ambulnnce aider for 8 year'i and a Brigad e Jllember 12 years, and during that time I too have noticed that when on public duty members have looked to me for the best way to treat a patient, even though some of them have twice as much Bl'lgade 'iervice as I have.

This has happened to me and three other members of OIH division, who arc also ambulance aiders, on numerous occasions.

Surely what M V, Moring suggests would be a good idea? Our identification shou ld be ometlling similar to that III the ambulance service when we PflSS the 'Millar Cerro A cloth b<Jdge, about 2 inches in diameter, with round it, and worn on the left sleeve of the jacket about 3 inche1> from the top. (As ill uslr<J ted),

We would then be recognised by everyone.

Yorh David Lee

In the past, certain hospitals have employed theatre attendants who needed no qualifications olher than being interested, capab le of absorbing some knowledge of caring for certain equipment and instruments, and learl1lng some of the procedures. Other hospitals have employed theatre technicians who have voluntarily trained to degrees far in access of the attendant with the help of consultant anaesthetists and surgeons, and finally sitting for the diploma of the In stitute of Operating Theatre Technicians. This diploma has never been recognised by the DHSS but was by the BMA but the pay <Jnd conditions were however common to both designa t ions

In future it has been agreed to a new designation in theatres, that of operating department assistant, with proper training facilities, a more appropriate grading structure, and some chance of advancement. At the time of wnting, pay and conditions, etc, are still to be finalised, but I foresee in the future an extremely worthwhile career for men and women who feel that this work IS what they would like to do. I would advise anyone interested to contact their local hospital secretary or The fnstitute of Operating Theatre Technicians, c/o University College Hospital, Gower St., London, WCI.

With the new hospital complexes now under construction, there will be a big demand for Operating Dept., staff in the future, apart from the nursing side. St. Ives Jilints. C. F. Brown

EXTRA LARGE DRESSINGS

from Ben R. Jarman, Staff Officer, Ambulance Cadets

Mr. Lee's suggestion of a badge for full time ambu· lan ce members

HOSPITAL ST AF F

from G F. Brown, MIOT, RMA, Divi ional Superintendent I feel that it is time that a recent finding, made by the Dept. of Health and Social Security, be made known to member of St. John, especially those who would like to be employed in hospital work other than nursing

L. JJo Ti

FIRST MOTOR AMBULANCE

from Mr s P Huttlestone

After reading th e article Ambulances, Past and Pres en , l th ought readers might be l11tcr es ted i n seeing our fir t ambu lance. p.hotographed in 1928, which operated the ambulance service in the War e eli trict untll a new vehicle was bought in 1934.

At a recent annua l inspe tion to celebrate years of St. John in War e one of the drIv ers of this first ambulance present. Hert ro rd )1 Pallleia fJuttlestone

My mcere thanks to Div / Surgeon A 1. P im (Ambulance Cadets) of Henley for taking the trouble to supply the information (Review J uly 72) I required concerning supplies of extra large wound dressings suitable for carrying in Brigade members' private car first-aid kits. [ have obtained samples from Vernon-Carus Limited, Penwortham Mills , Preston PR I 9S?\, Lanes, of a Vernald Sterile Ore ing Pack 10.3 9 Code 21539, containing one 50cmx 50cm gauze [issue pad. The minimum order Ul1lt is six dozen and the cost t 16 00 per gro s. It occurred to me that officers might wish to purchase these in bulk for re-sale to their members. To have two or three of these dressing in the car kit would be extremely useful and not at all expensive at about II pence each. Yorks.

Ben k Jarman

FILMS

DRIVE AGAIN TOMORROW (1972)

(Colour 15 mins) Free

Di tributed b y: Sh e ll -Mex an d B P Library, 25 the Burr o u g h s, Hendon, London NW4 4AT

Sponsor : Shell-Me x and B P Ltd

Y oung people give their view on driving and road safety in a new road safety film. A l though the film does not set Oll t to teach basic driving techniques, it demonstrates the correct JnLi safe way to driv

The panel was singularly unimpr essed with this road safety film. The cinema te ch nique e mpl oyed of flash-hack, disjointed script and listening to views of variou types of young people is modern but pointless. The road safety cliches are many. advice p l atitudinou and the general effect is one of pointJe sness. The photography is good.

Audience : Youth clubs and St. J ohn Ambulance cadets may find it possible to use as a programme filler.

FALSE FRIENDS (1967) (Colour9mins)

Distributed by : Guild Sound & Vi s ion Ltd Kin gs ton Rd ., Merton Park, London SW 19

Sponsor : World He a lth Organi sa tion

H ow a m ach ine operator who is an opium addict is per uadecl by his wife and foreman to have hospital treatment.

The pane felt that this cartoon-type film is first-rate. Obviously meant for an uns ophist cated audience it gets its message about drugs of dependence and medical advice ac r oss with clarity the panel's verdict was 'short and sweet'.

Audience : This film will have great value to St. John in overseas t erritor ies but it is good enough to be employed as a somewhat novel 'filler' in this coun tr y.

AIRWAYS OBSTRUCTION (1970) (Colour 23 mins ) Free

Distributed by : Allen & Hanbury s, B e thn a l Gr ee n , London E2 6LA

Sponsor All e n & Hanbury s

The film di sc u sses airways obstruction with reference to three patients suffering r es p ectively from chrunic bronchitis, emphysema and asthma

The pan e l considered this an excellent training film diagram. co lour a ll are good and it conveys its te<.lching with great clarity. It is too technical for St. John audiences.

Audience: Medical st udent s, nurses etc.

YESTERDAY'S TOMORROW (17 mins Black a nd White)

Di s tributed by : Guild Sound & Vi s ion Ltd ., Kin gsto n Rd , Merton Park , London SW 19

Th is film is drawn from th e files of a welfare officer. I t tel s th e story of a boy and girl relationship and how the coup le cope with their responsibilit y when the girl discovers she is pregnant.

Thi s artless little film s very elated, The st) les of the youngsters and specifically their attitudes appe<.lr, in 197 3, somewhat P egs P aper'. Of archiv<.ll int eres t on ly. Not recommended for further viewing.

THE X FACTOR - TAPE PROGRAMME

From : Infotape Produ c tion s, 50 Frith Street, London WI V 5T E

A 24 minu te audio cassette o r tape in the form of a radio play designed to inform teenagers of the causes, sy mpt oms, effecl'> <.Ind treatment of sexua lly transmitted diseLlses.

The panel cons ider ed this an excellent teLl ch ing ai d Wi t h out being mealy-mouth e d , it conveys in mod ern idiom a sympa theti c understanding of a ll factors surrounding YD and answers c le<.l rl y m ost of th e que s tions arising. Th e radio play neither preaches nor moralises but doe s set out all facts c learly and the inferel1l:es against promiscuity are th ere to be regarded or indeed di s r egar ded by the individual.

The opening is somewhLlt dram atic and ou t of key but 20

The St John Ambulance F lim Appra isal Panel which meets fortnightly ;-

Headquarters , consist s of doctors fir st alders and Visual aid experts who offer their servi c es for th iS mportant aspect of Visual aids Pr eviews o f those 16mm films re commended bV the panel a re r egularly pub li shed in the St. John Review

otherwi e the tape is \",ell nigh faultless.

AND THEN THERE WERE NONE (1972)

(Colour 19 mins) Free

Di s tributed b y: National Do c k L a bour Board, 22/26 Alb er Embankment, London SEl.

Spon or: National Do e k Labour Board

This f ilm detai ls the hocking tati tics of accidents in the clOcks and brings h o me t o all workers its 'nip' in th e bud theme i.e

'Notice I magine Pr even '. Types of <.I ll main accidents aft portrayed and the accident prevention Illt'ssage is accented.

The pan el wa very im pressed with thIS effective film; he theme is well thought out. th e production good, recapitulati OG brings the safety me sage home and the diagrams arc mosl helpful it is a model safety' film and demands unlimited

HELP IS (1972) (Colour 16 min s) Hire

Di st ribut e d by : Canadian Hi g h Commission Film Libr ary, I

Gro sve nor Square, London WI

Produ ced b y: National Film Board of Canada

Thi s film illustrates the necessity for the man in the street to b aware of the principles of fir t aid WI th specific reference II motor vehicle accident itualion

To film cog n oscenti the pedigree a ti ona l I; ilm Boar d 0 Canada indicates a high stan dard of production thi s fil n certain ly ha that it is of good length , co lourfu l. of grL'at and punches its mGssage home, It succeeds admlrabl) [ pro elytising the nece sity for first aid i nstrLlction for a ll.

It i s a pity. however, that our experts do not con ider first JI portrayed in the fi lm a faultless. The unconscious patient ShOli11 be p laced in the recovery position, a tenlc dres ' ing is placed or top of a ring pad and the film not portrJY adequa lt exa minati on or diagnosis the use of the p111<11 board migh t ha., been amplified also.

one the within the concept of the film these afl criticisms of detail; the overall impreSSion is one of e'<cellence

Audience: Universal. Of gleat value to St. J ohn.

DON'T PUSH YOUR LUCK (1970) (Colour 12min s) Hire

Di st ribut e d b y: Guild Sound & Vision Ltd Kin g ton Rd Lond or SW19

Produ ce d by : Har vest Film

This film portrays a real life story of a man tragiL'a ll) blll1ded an on-the-job acci d ent and what it meant to him iln d his filll1il )

The panel considered this an excel lent accident preventIOJ film that by IllCJIl'l 01 its SJd eX<JmplG of a mdn blinded b el1lp h<.l siscs the importance of wearing protectIon tl' equ ipm ent ilt illl times.

Audience: Will have great value LIt I ndu triLlI Training ('enW and Apprentice TrLlinIng chools. All at risk personnel should St this film.

R ESPI RATION I N MAN (1972) (Colour 25 mins) Hire

Di s tribut ors: National Audio Vi s ual Aid , Libr ary, Pa xtof

Plac e, Gip sy Road , London SE27

Produc ed b y: Encyclopaedia Britannia

The respiratory system in man is stu di ed and ex Illu strative lab ora tor y C'I:periments show how the exchange 0 oxygen ilnd carbon dioxide is effected.

The panel cons id ered thi a very int eres tin g film with notubll laryng osopic photography and excellent LIse of X-ray diLlgral11S It portray lun g eX]1L1nsion. Pr od u c ti o n vLllues LIre first rate ,llld th t whole fi l m very professionLlI. Il owever, for f ir s t aid c asses till' fi lm is pitched LI a lcve I tha t ca u sC' the llL'Cd () f til e se rvi ccs of, do c tor or lay instructor to answer question after creening.

Audience: MLlinly medical LInd nursing s tud ents but cou ld b( sc reen ed t o experie n ced first aidcrs and at hyg iene co ur ses.

NEWS from SCOTLAND

T H E LIBRARY of the Prior y of scotland, built up after 1947 through the efforts of Pr ofessor Mackie and th e generosity of Lord But e, is beginning to attract donation s in its own right in cluding a particularly generous gift from Mr. Fergus J ardine. Of cOLir e it does not begin to riva l the magnificent co ll ec tion at Clcrkenwell, but it docs con tain some very rare books. It s she lv es hOllse works o n th e history and constitu tion of th e Order of Sl. J ohn and it various branches, on other religious military and ch ivalri c o rder s and on a lli ed historical subjects, togeth er with books wr itt en by members of the Ord er In Scotland. We hav e phot ostats oj the medieval c hart e rs of the Pr eceptory of Torphichen, n ow in Regi ster I [ ouse, and the beginnings of a microfilm co ll ection. Great sums have not been spent on it , but now that donations are comi ng in [ am sure that someone will express doubts as to whether a charitable order s h ou ld spend money granted to it o n the acquisition of books. I hav e heard the argument that while it i of course natural fo r members of ollr Order to be inter-

OVERSEAS NEWS

CANADA

I or the third year Woodward's Stores of Vi ctor ia, BC , ran t1leir 'Opc rat ion Whe elc hair ', when thc departmental IS open Iate on one evening Just before Christmas es peCIa ll y fo r blind and wheelchair restri c ted t o be able to do their C hristm as shoppmg

The regular publ ic is excluded on thi s occas Ion so tha t tIl e I [ b ,ess ortunate c iti zens cLln rowse a nd shop to their hearts' contcnt SJi\ personn e in the V t I IC ona arca wcrc to l elp NUrSII1 IJ and d e> crusa er nurSll1 a members we:e presen t in eLIse of cmergency a lso to aSS Is t th e handi ca pped in the women's w lshrooms. Ambulan ce and crusader ambul ;ncc mem bers he llJed I d c h ' '" oa and unload the whee lCdses from vehic les and assisted n the h meln s washrooms. Nursing cadets aetcd e pers to th br u f' e Ind an d pushed the wheelchairs o peop e 0 re s tri c e d Ovcr thirty St John v 0 Iu n teers he pe.dO, VCI 500 wheclchair

ested in its hi story and institutions and right that a few book shou ld be collected together to cater for their needs, such a co ll ec ti on is a l uxury t o which shou ld not be div erted cash tha t would m ore proper l y be pent on c harit y.

This argument would ha ve some force if it were not based o n some quite unjustifiable assumptions. It should be emphasised that the Order itself spends very little on the buying of books and there is no evidence that the donatIons to the library would otherwise have been given to the Pri ory or associations. More im portan tly, the librar y shou ld never be regarded a a mere luxur y, for it provides a service i!'llts own right to the community and therefore contributes to our work. In so far as it welcomes visitors and allows them to read what th ey want from its helves, which contain books otherwise not easily available, it ha a function which is particularly re levant to Scotland where there arc many good historians but not the library facilities to be found in the South-East. I n Edinburgh even the National Library of Scotland and the

University Llbra ry arc not really adequate LInd nearly every Scottish historian has to mak(! periodic visits to London, Oxford or Camhridge. Secondly we are now associated with the J nter-Library loan servIce. Our catalogue IS duplic.ated in the ScottIsh Central Lihrary which IS consulted by indIVIduals and from all over the country. We are co mmitted to lend all but the most precious volumes of our to accredited libraflGS that ask for them. Our library is not merely for our own personal enjoyment but IS also avaIlable to the world of scholarship.

There is 111 Christian history a long tradition of learmng attached to religious orders. In the early Middle Ages it was monastic libraries that preserved for us the great works of the classical and patristIC ages and monastic chroniclers who recorded the events of their own times Most education was provided first by the monasteries. then by the cathedral chapters who in the twelfth century contributed to that outburst of learning which helped to lead to the foundation of t he univerSities. By possessing and fostering a library the Priory of Scotland carries out a traditional and very worthwhile role.

Central Africa a new ambulance is presented to the Brigade

h and icappcd peoplc at te nded, as \\ell as blind people.

CENTRAL AFRICA

During thc autumn a ncw ambulance \\a, donated b) Salisbury Round Table o 1 to the Sa li sbury Area of St. John Ambulance Bm:ade. Round Table Chairman, \I r WI;lle), made the presentation to Col. D. H. Gr:linger the Com mand e ry Commissioner (pho to and Dr. N F C. Gane, alisbury Area Commissioner, accepted the ambulance on behalf of th e Brigadc

Three cadets representing St. J ohn in Rhodesia \\cre selec ted to spcl;d three \\ ecks in London and th e Isle of \\,i ght bd\\een Julv 30 and August 20, a t th e invitation of the

and Keith Hadden of Bulawa y 0 arri\ cd bJck on August 23 aftcr an intere ting and instructive sta) in the Lnited Kl11gd om. :-'lemb ers of the 1st Salisbury Ambulancc Di\ ISlon and 1st Salio;bur} Nursing DI\ took part. b) Imitation, in the South AfrlcJn Int er-Provincial CompetitIons at Kimb erk\ on October 14. The team from the fursing -DIVision \\as awarded first place. the I ndivid ua I 1\\ anI goi ng to Han e\ of Salisbur). The I\.mbulancc Di\ ision \\JS third in the first <lId competitions. The Commander) Adult CompetItions \\ en: held In Salisbur) on Al1I..'l.lst 27th e\'en trophies in all \\ crc \\on b} the 1st alisbury Ambulance and urSl11g Di" ision21

J. R-S

(Prince of Wales's) District. Pamela Chinn of Salisbury and David Poxon

NEWS FROM THE DIVISIONS

CORNWALL - St. rv es Corps of the Salv::Ition Army and the Sl. Iv es Divisions of the Brigade have held a hristma Carolaire a a fund raising event for the Rrigade for severa l

The IJtcst Clrolam.\ ::It Sl. l ve:, on December 17 1972, was attended by an audience of about 400, including the Mayor ancl Mayorcss of St. Ives The rrogramll1e included community carols, led by the SalvaLJon Army Band, itcms by different sections of the Army, and two carols by the local Brigade choir. 0 charge wa made for admission, but a co ll ection raised fA 7 for the St. Iv es Divisions.

On Decemher 21 the Mayor and the lI eadmaster of the l. Iv es County Secondary School presented first Aid and Proficiency Certificate to the St. rves Nursing Cadets This was followed by a short play and concert gIven by the cadets for their parents and friends, and Father Chnstmas arrived with a small gift for each invited guest and the children.

1

CUMBERLAND - The annLlal first aid competItion for Cumbria police took place during December , the team winners being Western Division and the individual Sgt. Wtlson, of IIQ

At another December competition the Dr. Isaac trophy wa won by the Workington British Rail team.

LANCS - th e CaIne Centre of Sl. J ohn Ambulance was presented with the CO/ensHardy trophy recently. It wa donated by Lord Cozens-llardy, WllO IS the BaIliff of l::gle and Grand Officer of the Order of St. John of Jerusalem

It is a I1Ine inch model in silver of the Knight of t. John in the splendour of

County PreSident Lady Violet Vernon presenting an overhead projector to ChiPPing Sodbury and Yate Combined DIVision's super· Intendent, E R G Pearce a gift from the Nancy Edgar Memorial Fund

fu ll armour. The award is co mpeted for eac h year by over forty ambulance centres ancl divisions throughout Lancashir e and it is awarded to the centre which has made most progress during th e year. It is the first time that CaIne Centre has won the award since it was donated some twenty years ago The trophy was presented by Lord Cozens-Hardy to the Co ln e Brigade and Association Secretary Mrs Edith Gardner, and Mr Allen Exley , the President of Cotne Centre. CaIne Ambulance DlviSlOn is one of the oldest diviSIOns in eXI:-,lence, as It was formed In 1886.

SURREY - Bargall1s galore were available at the Surrey St. John County Fair held at the Dorking Halls in December. The Fair was organi ed by the St John Council for Surrey and Wised over £,700

It is the first of servera l drives that are being mad e by the Council to establish an en dowment fund from which grants can be made available to lo ca l division in times of financial need or for speCial proJcch

The Fair was opened by the Recorder of London, Judg e Sir Carl Aarvold

SUFFOLK-Duri ng last June St. John, Suffolk, probably made history, for on that day the whole of the Whitton Comb:ned Cadet Division W::IS solemnly enrolled at the Church of St. rhomas Ipswich.

This is the first time within living memory that an enrolment ceremony has been held in a Suffolk parish church. The form of the ceremony followed the pattern suggested by the Order, and the Mayor of Ip swich whilst not presuming to address the congregatIOn' rec ou nted ome of his memories of his association with the Order both in Malta and the Holy Land. The servIce was followed by a parade outside the church, after which Lady Blanche Cobbold, County President, presented first ald and re-examination certificates.

OBITUARY

Frank Frewin, Corporal No 17 (Wimbledon)

Ambulance Division, died on ov c m ber 28. An cxpert lJl the compctltlon field hank Frc\I,.in regu larly con tribu ted articles to the Revlcw

COMMANDER (BROTHER)

Desmond Gurney Buxton ( orfolk).

Ronald Alfred J:.dwards (Cornwail).

C lif ford Ralph Pilbeam SR IICAP. (London) Pcrcy Arnold Reed (Birmingham).

Major-Gen. James Parlan e Baird QHP, MD, I· RCP. (London) Ir Hcnry I runk Harding Jon es, GBL (Bucks)

ASSOCIATE COMMANDER (BROTHER) L t Col DaVId Kubry\\.. CD (Canada)

Peter John Jam es Wren, [\10, JP, VRD (Lanes)

Claude Ilankins (Herls)

lIarry Judge (Gloues)

Thomas Joseph Murphy [\ 113 ('hB (Birmingham)

Capt. TllOmas l od ('atJo\\', CEI R (Lanc\)

Alan Davies Wilson , BSc , 11i\ echl. CL, I BI[\-1. (Surre) )

John Clive ilkads (Lincs)

Karl Biden- teele. \10. \IB, B ', \IRCS. LRCP , DPh , DPi\I, DIll (Wilh)

Fd\\ ard ('oppin (Gloucs)

Major orman AdrIan Boyd. MB, BS, RCS (London)

Brig. Eric Da) kin Stanhope, MBF. LOS, R(,S, HDD (London)

Lt. Col. Richard Keith Levi ck, TO, 1IIB. ChB, MRCP, Dt\IRD. I · FR ("y'orks)

Col. John lason I orbes, DL. J P (Yorks)

AS OFFICER (SIS TE R )

Shclagh [\Iary Chalmcr, Mrs Shirk) (Beds)

Col. 1\ argaret Pratt, ARRC, SRI, QARAN(' (Lssex)

Joan Mar), Mrs. Ile\\itt orfolk)

AS SERVIN G BRO T H E R

The Revel. John Andre\\' Tibbs (Sussex)

William Richmond lIatch (Devon)

Charles Vil'li eg (London)

Alan Ward Sclbrs (York)

Stanle\ Chad\\ iel- (Nott )

John Tanse\ (Staffs)

William HeilfY Charles ('ollins (Lancs)

, <ll11ul'l i'ranl ls [<lrshall (NOlls)

Reginald Velnon Rlillge (h,ex)

Iknnls Patl'lck Kennedy, I [eRr () urks)

Arlhur Richard Withall ( urfey)

Vincent William Varley ( lO llS)

Joseph Creenhalgh (Lanes)

olonel Waller CYril /luff 'I'D (, alop)

Stanlev Ln c Gunner ( unev)

Leslie -hank Grace ( onh,tnls)

Ilaroid Bottol11ley (Lanes)

Ronald l-dward [\lcdus ([\llddx)

A[an \emy Gra), 113 , BSe (Nalls)

Brian 1 eGreslc'v (L\sex)

Ronald Rose. MRCS LRCP (NotIS)

b.h\ In Taylur, J p, (1 aill's)

Ronald George llenry Tim ms (Ken t)

Donald Walter Illron ( orlilanh)

Joseph Ilarry ('arteT (Leks)

A, G \Ianley (Surre)

William Leonard Street ( oIls)

Leslie Wescott [lodges

Stanlc) Dodds ClInlhorpe (Llncs)

John Tustin (Staffs)

George William Arnold t London)

Sanll(cl aise (Dcvon)

Dougla s hanci s Smith (. urrey)

Arthur Blak e (Northanls)

Oswald rank Dalellport (lillcs)

John L dllard \10" ( \lldd\)

Thomas h,lward Barnes

John rl'd enck Pa) ne (Nortllanh)

Ri c hard I rIlesl Soper (london)

Arlhur Weaver (Nalls)

i\laurice hh\ard Caulkell (OXOIl)

Brllce Chivers (Sol11l'rsel)

Wilfred Thomas Slokes Allnull (Bucks)

SE RVIN G SISTER

In ne [\la y, ill! , Libb y ( D eVOll)

Am)' (;corgilla , Taylor lldtl x)

Nelill'. [\Iiss illus c hamp (Yorks)

Annie t\i<l r1<1 II " Jenkins (Sune) )

Allee [\Iar!.!aret, [\11,,; ('ra\\,sllll\\ (Yorks)

Nancy Iklk illrs Walford (Sum: )

Nellie , Duckll or th (Yorks)

Iris Normanda, [\Iiss Clark (London)

Mar) Leslic Dorolhy, [\lr\. la It he\\ (Surrey)

helvn Pollard (York s

Louisa Annlc, 1 rs. Archard (Worcs)

Audrey illar y Jean \I rs. Payne (Rucks)

I li en nn , [\Irs Jepson (Yorks)

Jes sie illrs. llun1P!1l"1l's (\\ or cs

Susan 1I7abeth, \11'\ Rose (\\al'\\ leks)

lIilda [\1['" tolt [Yorks)

1m [\!a y. \11' lenl on (i\ lldd\)

Betl\' \lan.!lIl'n c, [\Ii\\ Woodh ern, SR\ (\\ 0 iTS

I thel Anne, Mrs (LIIK')

Irene I:katrIl'e 11' ,. Blaektll1 tl-"llIlts)

Anne L:li/abL'lh Lallr<J [\Ir\ Coil', orl'olk)

PI1\ llis. 11' ''. Park er ( orthanh)

1 <Inn), Mr s. I elloll s (Wores)

I Il een, i\la) I\lrs Bu cknell (Surrey)

iI\;lrJ orIL' JOdn \11,. mblll1g [\\,ills)

Joan 1 Ill abeth \ian c, \lrs Alkn (\\or es)

Sheila [\lary. \Ir s, Bro\\n (Yorks)

cilna. i\lrs CL'ldL'f (Lanes)

Bett\ \11\\ Burnell

Anne, \lrs ('oopn (Yorks)

CLASSIFIED ADVERTISEMENTS

REVI EW CROSSWORD No 2 (73) Compiled bv W A. Potte

ACROSS :

I Inflamcd papule In a Communist lo cali ty? (3.4). 5. Tabl e salt treated for prophylaxis of goitre. (7) 9. Surgical instrument for entomologist studying transmission of malaria? 7). I I The hallux is the big one. (3) 12. Outer covering of brain and spinal cord. (4).13. Fish obtained from 4 down. (5).14. Baby with circulatory deficiency (4). 17. Points to redesigned receptacle for spittle and sputum. 19. Pat returns and is finally produ c ing a cover for th e table. (5).22. Member of one of the ancient races of Northern i:.urope. (5) 23. Virulent epidemic diseas e controlled 24

by vaccination (S) 25 A to encourage wrong-doing 28. La'(ative pods from caSSIJ plant. (5). 30. Disturbed mal clI::. ablcd In J klWer 11mb (..t) 3 \ ..,oulld bcglnnlng III rochemcnl. (3).34, Reali) strong (Ir11 j"llr , coltish ophthalnlOlogl' whosc pupil diagno"le tJbcs dorsall" (h.t)) 35 III :,trYl'hnlnc POislllllllg (71. 36 OrgLI\1 storing Ltrll1e or bde, (-

DO WN :

I. My deer produce.1 cure. (61. 2 \ \\ for vlL'tory end, hercLllla r mu,>culdr Ji"\Htle\'. (LJl. 3. ullell pwtru..,lon of the lip (4)

I:.XL lamatlOn of Lli pleasure or teacher. (5) 5. Highl y infecti o lebrilecOllditioIl w1th re'>plratof y traL'lll1\ohel11cl1t (9). b. Ilk el to carn infection wllL'n pres e nt 111 a wound. (4) 7. W1th alIlt all fish onese lf for trouble. (5) X. Suppl) Illcdicim according to prescription X) 10 Ind ian cnr\1 fnr horse dI1u spider. ( 3), IS A cute, .marting puin (5) I G. Where one I11lgl)' buy protective covcnllg for injured finger') (5). 18. TY[le a nm ing for which Scot tribe could be el11[l oyed. (<i). 20. Orgal fallen from its normal position (9), 2 1. OphthalmiC conditl ol preventing a clear 'view of the \\aterfall') 24. The I ren d disturbed near le ss obese person (6). 26 After hesitation, gOI hael110static drug from fungus growing on r) c (5) 27. Bridge 01 1879 disaster. (3) 29 Wealthy Indian ruler with all o ld shiJlin l from the north (5). 32. Devis e a method of procedure. (4). 33 Main nitrogenoLl co nstituent of urine. (4)

SOLUTION TO CROSSWORD No 1 ( 73)

ACROSS :

1. Ure.a: 3. Br o. n e hi.ti s; 10 Stoic: 1 I Fit; 12. U R R A .; 13 Oxygenate; 14 I:.nter; 15 Pi cks: 17. 20. Dover road 23. Dre ss; 24. Apr.on: 25. Knock-kne e; 27. Luna .r; 2R. £:1m ; 29, Er-recl:30 WasserJl1ann;31, User.

DOWN :

I Un s topped : 2 Fhon y;4 Ref.rain :5. Nutrnegs;6. l l ouscmaid \ knee; 7. Ter .ato m ,ae; 8, st.air; 9. Accessory nerve; 16. Cove.rings 18 Yea: 19 Suspender; 21. Oak - beam; 22 , Do .o rman ; 24 Agloll 26. N

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AT RANDOM

by Watkin W. Williams Deputy Commissioner-in-Chief

COVER :

Variet y is the spice of life, they say Leicester cadets (L) D iane Tingay and Kim Hartopp visit the local fire -station as part of their training for fire.fighting certificates ; and (R) Cadets Jasu Patel and Suzanne Smith viSiting a home for the blind (Photos : Peter Jackson)

LAST OVEMBER, Dame Barbara Cozens and attended, as official representatives of St. J olm Am bulance, a national symposium on the Care of the Dying, held at the Royal College of Physicians under the aegis of the Departm e nt of Health and Social Security. Sir Keith Joseph himself was present to open the day's proceedings, but was unable to stay on for as long a s he had hoped , and was for most of the time represented by Lord Aberdare , Minister of State - better known to us in St. John as Prior of the Priory of Wales.

The f i rs t s peaker was that s tar o f comedy , Sheila Han co c k , who des c ribed in the most mo ving terms her own persona l e xperienc es wh en sh e was t o ld th a t her mother was suffering from terminal can cer and had n o t more t han nine month s to live She became overwhelmed by a sense of her own inadequacy because she didn t know how to give her mother the loving care and attenti o n that sh e wanted to give , and 11 0 o n e seemed able or willing to tell h er how she could learn , nor what services ( su ch as the Marie Curie Foundation , and the var ious facilities described on pp 26-27 of our ursing Manual) were avail able to share and relieve the weight of her responsibility

So she had to find out by the hard way . And then , when it was almost t o o late, someone told her about Dr. Cicely Saunders and St. Christopher ' s Hospice at Sydenh a m Almost too late but not quite. For soon after her mother died she had the terrible shock of being given similar new s about her husband, the actor Alec Ross . He at once became a patient at St . Christopher s whi ch meant that much of his time was in fact s pent at home , and that when he h a d to be actually in the Hospice his wife and their 8-year-old daughter could very often be with him. Together they learnt to come t o terms with the situation ; they learnt to bani sh the fe ar o f death a nd t o get rid of the idea that death implied 'failure or that it was the end '. And by this lovingly shared experien c e they were dr a wn closer together as a truly happy fa mily , in strik i ng contras t t o those families where the unspoken fe ar of death and the spiritual isolation of the sufferer build up a barrier between husband and wife or between parents and children And so it came about that Alec Ross lived his life happily and to the full , even while h e was dy ing - to such an extent that he and his wife enjoyed an evening together at the theatre two days before he died

The address given by Dr. Cieely Saunders herself a t the symposium is reprinted on page 12 of this issue ; and I hope that in a future issue it will be possible to reprint another addre s that we heard, about the ca ring team whose members (both professional and voluntary) should be av a ilable to help those in all walks of life who , like Sheila Hanco c k, are suddenly faced with the respon ibility of caring for loved ones who ( at any age)

( c o n tinued 011 page 11 )

Keep it UP

THE CORRECT FIRST AID CAN CONTROL

HARMFUL SWELLING AROUND AN INJURY

by R. A. Elson, MB, FRCS

I FLAMMA TlON is the r esp o nse of living tissue to injury The injury m ay be due to trauma or from the harmful effects of an infection Whatever the cause, the basic tissue response is the same inflammation. What is its purpose?

Inflammation is the process whereby the body brings to the damaged part special cells and fluids which, in the first instance, neutralise the harmful agent, and then start the repair processes which are going to restore the part to as near normal as possible For example, if the damage has been due to an infection the inflammatory process br ngs white 'cells and chemical substances which first kill the bacteria and then start t o repair the area.

Reginald Elson is a member ul the St John A mbulallce Panel oj' Consultants.

important chemical substances (antibodies) which will destroy harmful agents such as bacteria; the cells include both red and white blood corpuscles, but it is the white corpuscles which assist in the neu tralisation of harmful agen ts, engulfing bacteria or other foreign material, and also commence the mopping-up process whereby damaged tissue and dead cells are removed. Often, red cells leak out as well and produce reddi sh-brown discolouration of the tissues, like a bruise. ext, the uninjured cells of the sur rounding tissue tart to multiply and

new blood vessels grow Ihat the destroyed area is bridged eventually replaced. Finally, a scar fo rml Sometime, too much tl \SL accumulates and, In this case, pus formed. It accumulates Jnd 10rms absce s Usually, an abscess will work I way to the nearest surface, bursting so that its unwanted conte m (mostly dead cells) can be got rId of this i the body's way of eJecting dead damaged material from the tissues have all had <l boil which starh as 3' infected hair follicle the yellow he , which eventually bursts IS <I tmy Jbsce and is typical of this important proc e just descrIbed

Plate B. Elevation of the lower extremity for injury or infection of the foot. It is achieved by raising the foot of the bed as well as the pillows and this can be done by putting blocks of wood or some books under the legs, in the home

fluid called lymph ba c k i nto tlle vell1S, just before these return to th e heart. Lymph contains much protein, a s well as fat droplets.

The signs of inflamm atio n are well known : pain, redness, swelling and local heat All of these are due in part to an increased blood supply and in part to the leakage of fluid from the blood vessels' this fluid co ntains much protein as well cells. It is the protein which include s 2

Diagram A shows tin circulation which les fanuliar th a n I blood circulation. It controls the am Ol![ of protem in the tissue flUids and IS CJll the lymphatic sy tem. It 1 a separate 5e of capillary-sized tubes which Join up for111 eventually a much larger tube (t thoracic duct) which discharges a mil k

The protein-rich fluid which has leaked out of the c apillaries during inflammation descnbed ab o ye must be collected by the lymphut ic s I there IS too much fluid, or if the lymphatics are overloaded, t he fluid stugna tes 111 the tissues and produces unnecessary swelling and consequent pain. Worse , unneces ary swelling encomages of the moving parts, especially of the hands or feet, and this slows recovery enormously in the healing stages due to the stiffness and discomfort which is produced.

Some swelll11g always follows tr a um a (such as a contusion) or an infection, and is part of the defence process; too much swelling is disadvantageous. lIow can first aid assist in achieving the right balance?

the veins because, with the arm dangling, the blood has to climb up the whole length of the limb in order to reach the heart. As a result, the blood coming out of the capillaries and being collected by the vems becomes severely hampered in its upward passage and consequently the pressure in the capillaries must rise; in its turn this rise in pressure results in more protem-rich fluid being squeezed out of the capillary walls which have become stretched and more porous, like a sieve.

Diagram A B ood is pumped by the heart a ong arteries and eventually re ach es the ca p illaries During its passage through the capillary protein - rich fluid (serum) leaks out through the wall (represented in this diagram by small a rows) This collects and bathes the tissue cells. It is collected by the lymphatic vessels and returned to the blood stream near the heart. Most enters the subclavian veins through the thoracic d uct D u ing inflammation, the capilla r ies are distended and their walls stretched so that the po r es are larg er and more pr otein - rich fl uid esca p es. The increase in the amount of tissue fluid, produces much of the swelling of inflammation

return i ng

In most instances, If tJle mjmed part can be elevated above chest level. the tendency to swell can be lessened. U ually, this is possible and safe in injuries of the extremIties; in hand and fo.ot. lI1fections or in crushing type ll1Junes of these parts, the patieltt should be positioned so a to achieve elevation. How does this work')

Swelling will be Ie sened if, flfStly, the leakage of protein-rich tluid from the can be reduced, and, secondly, If ItS removal by the Iympilatics can be When the hand, for example , IS dangled, the vein can be actually seen to dlstend as blood collects in them' if YOU have a painful lesion on the such as a recent bruise, you will find that it thr.obs and hurts more when dangling. ThIS effect lS due to the impairment of the blood flow from tile capillanes into

Elevating the hand has just the opposi te effect and the blood can now c ourse freely down towards the heart. The blood coming out of the capillaries into the vein is no longer impeded and the r e fore the capillary pressure is reduced. The reduction in capillary pressure causes less protein-rich fluid to leak: out of them. (For similar reasons, elevating a part will reduce low pressure c:!pillary, or venou bleeding, and the cla sical example of this being a useful first aid measure i in the case of haemorrhage from varico e veins of the leg. In _ uch in tances, the patient hould always be laid flat on the floor and the leg elevated).

Eleva ting the part also assi ts in the disposal of any protein-rich fluid which will have leaked out of the capillarie a a rt:sult of the ll1flammatory respon e. It is hoped that when this protein-rich fluid has done its work combatting the damaging agent, it will flow away from the area and become ab orbed by the lymphatics. Again dangling the part tends to make any fluid accumulate and the lymphatics find it less easy to conduct the absorbed fluid upward Ulan downwards, as would be expected if the part were elevated.

Plate c. A simple method using a small sheet and safety pins for elevat ing the upper limb for a hand injury or infection. It is often used in hospitals

How to elevate the part

In the upper limb, the subject should sit so that his elbow rests on a convenient surface such as a table, or as is commonly practised in hospital, suspended 111 a roller towel or some similar devlce. To be effective, the part must be above the level of the heart; to be safe, the patient must feel comfortable. (Plate C).

For the lower limb, the patient must lie flat and the injured leg supported on plllow , again comfortably. The bed foot can be raised in addition. (Plate B).

When not to elevate

As in all first aid, common sense and con ideration of the whole patient are essential. For example, never try to achieve elevation as described here in the pre ence of suspected injuries such as a fr acture or joint damage in the knee or el bow, or a bove. A sling is much more suitable for first aid purpose in the upper limb, or the usual form of plintage for the lower limb in these circumstances. ever eleva te if the arterial circulation seems to be impaired.

In the ab ence of contra-indication, the earlier elevation is started the more quickly will welling be controlled. Pain is usually reduced

Bloo d to Vein s vein

Changing Concepts of First Aid

TO MEET TODAY 'S LIVING CONDITIONS

B. stamh for breathing by (lrtificial means if indicated, and:

C. for circulation and its restoration by external cardiac compression when necess ary.

by J. D . Cameron , MB , ChB , FRCS ( ED )

BEFORE THE LAST WAR, all trauma was cared for by general surgeons; anaesthetists and orthopaedic surgeons were just beginning to be recognised.

Artificial respiration was by the Schafer technique, Sylvester's method and open cardiac compression being reserved for the operating theatre situation. If a blood transfusion was required, a donor, not a bottle was requested, and the prescriber did his own cross-matching and collection. First aiders were enthusiastic amateurs doing their best within the limits of current knowledge by dispensing smelling salts, splints, and sympathy.

Today we live in a different world.

Antibiotics and advances in immunology have abolished many of the killer diseases of youth. Life is lived at a greater speed, with a higher standard of living in a changed and ever-changing environment.

To the problems created by the motor car can be added those of increasing mechanisation in the home, the factory, and on the land, together with the risks inherent in the more adventurous sporting and leisure-time activities of today.

Within the context of my subject, the effect of all this is that accidents are now the major cause of death in young adult, and coronary thrombosis is approaching epidemic proportions.

First aid is often regarded as the action, or perhaps more frequently the inactivity due to ignorance, which fills the time between the injury or onset of illness and the arrival of expert help.

4

Correct action at this time, or in another

Dr. Cameroll is District Surgeon, Duke of Lan cas ter 's District , allu Group Medical Officer, Pilkillgton Brothers Ltd

His article is published by permission of the Trallsactiolls of {he Society of Occupational Meuicine.

context 'masterly' but intentional inactivity , can save life prevent complications, minimise re ulting disability and reduce the period of incapacity. Miles had defined first aid as the assistance gi ven in a case of inj ury or acute illness by a lay person together with such expert help as may be available until the patient reaches ho pital or other si milar professional help. Assistance provided by the doctor or nurse on site is in this definition first aid.

The appreciation in the mid-1950s that mouth-to-mouth artificial respiration was far superior to the manual methods, and the realisation a year or two later of the possibilities of external c(lrC\iac compression, together with the concept of intensive care, have completely revolutionised resuscitation techniques

Modern (lccident units are accepting that their responsibility commences when the emergency services which they h(lve trained arrive at the ite of the incident. One such is that of Garden at Preston. Ambulance attendants in his area (and many others) are no longer porters or stretcher-bearers. They are members of his team, trained in his department, as (lre police and other rescue service personnel.

A two-way radio Imk eJ1(lbles them to seek adVice or receive instructions at Jny time.

All these efforts are of no avail if the patient is allowed to die before thi expert help arrives. Asphyxia and Cl[(lidl arrest are the two major emergcnclc,>, ,lnd therefore cardio-pulmonary re"ll"citatlOll 100111'-, large in any discu'islon 01 emergency care. Irreversible anOXll changes In the brain occur in about 4 minutes. Amblliances arrive at varYing times, rarely less than 10, and on a\erage about 20 minutes, and of COUPil' ill rem 0 te by dis ta nce 0 r by ti I11C in hcar) traffic, much later. Your lIfe ther efore, III these circumstances, depends upon the person near you at the time. The voluntary societies and other silllila: bodies now accept that one of their Jl18jOI responsibilIties is the training of the public at large in the few basic bu essential resuSCitation and life-saVing techniques.

Much has been written on the suhjeci of carclio-pulmonary resLlscitation, unu the help in prep(lraliol1 received from thi Manual of Cardio-Pull11onar) Resuscitation of the World Federation ot Societies of Anaesthesiology Illust br acknowledged.

Until expert help and additionol equipment arrive, the essentia requirement is to maintain oxygenatiOn of the patient. This 1l1(lnual describes A. S.c. of the problem:

A. is the airway in the unconscioLis 01 obstructed patient;

Il has to be accepted that all cannot (lbsorb and under<;tand wllat Ideally one would like them to know. A tier <-;y')tem of learning is necessary. I he general public should be t rained to recognise (lsphyxia and the blocked airway, and t(lugi1t how to clear and maintain this airway, and how to perform mouth-to-mouth artifici(ll respiration. In addition they should know how to apply pressure in the control of haemorrhage and be shown the pmi tlon tn which to pl(lce the unconsciolls but still breathing patient. All dvailable media should be Llsed to this end. In orway all school children frol11 the age of 10 receive one day's instruction per year. In ])enmarh. an Jnnual televi\lon programme dcvoted to resmcitatlon IS given at the stJrt of the bathing and hoatlng season.

t'>lore <Jdvanced instruction he provided for other groups according to their and ability to assilllilate the necessary techniques. Ideally they should all receive training tll at the le,el of the St. John Ambulance Digest of Flr Aid or silllilar elementary first aid hooh.. The four-hour non-certificated L'ourse sponsored by the St. John Ambulance for housewives, or in ,lssociJtion With the Automohile Assol'ialion for motorisl'i, are deSigned for thIS purpose. Special groups 'uch as members of the voluntary societies, police and other re.,Clle sen il'es should be trained to at the first ,lid certificate 1c\\.'1.

Ambulance crews and selected members of other sen ices should recei\e more advanced instruction and hold more ad\anced It is suggested that they could with advantage be instructed in the use of respirators and the ddministration of oxygen.

County dmbulance trall1ing centres are now providing advanced training. The Medical COlllmission on Accident Prevention is sponsoring d courSt' of instruction for selected ,Imbulance personnel in the departmcnts of large hospitals in the south and south-ea t of

The role of tile members of the volllntury first aid society is changing. Their place in t:lllergency resuSCitation is similar to, hut ohvlously much more expert than , that of the ordinary l11ember of the pubill'. rheir public duty In l'rowd situations or where the needs for emerge ncy fi rs aid ea n be p red icled, remains undilllinisiled, <IS does their value to industry. They now in addition, however. a big contribution to to the in i ng of he general publ ic in el11ergency tcchnlques.

first 1Iid l11ust be adj\lsted to meet the

needs of the SItuation in which it has to be practised, and nowhere is this more true than in industry. The resuscitation of the apparently dead and the arrest of haemorrhage make a dramatic impact upon the layman This should not be (lllowed to blind one to the more mundane but extremely important aspects of first aid met with1l1 industry.

The contribution which the first aid staff in the factory can make to productivity by prompt efficient first aid in, for example, prevention of sepsis, (lnd also by the treatment of minor illnes or injury at work, is not inconsiderable. Whilst the C(lre of minor illness cannot be described as first .lid, in tile right circumstances it certaJ11ly be the respon sib lity of the first aid man. A tier system of training IS as appropriate in the industrial selling as it is in a more general context.

All employees should be trained to the level recommended for the general public, and in addition in the personal management of those injuries or illnesses which could possibly result trom Jny particular hazards in their \\,orking environment. This is the principle of self-help, so well de'cribed by Ward Gardner and Roylance in their writings.

In the gl:.Jss industry for example it is important to teach men the initIal

TUNING IN TO THE FUTURE

management of a glass cut, and those working with hydrofluoric acid how to irrigate their eyes, the importance of washing off skin contaminatJon, and the significance of the latent period between skin contact and symptoms, so that they will return for treatment even if they have left the factory when symptoms arise. Industry can make a significant contribution to the general pidure by extending its 1l1struction to the le\'el of t he four-hour uncerlificated courses already mentioned.

The worker responsible for a first-aid box JS Llsually, in addition to his normal work In the factory, the designated first aider who must by law hold a current approved first-aid certificate. Thi' IS a minimum requirement. and he should be encouraged to go on to more advanced certificates and train particularly to deal with any special problems of his industry.

A much higher standard of training is required for the full-time man in charge of a first-aid rool11. He should be in possession of the highest first-aid '. It is probable that In future these advanced qualification will depend not upon a special examinatJOn, but on the ability of the individual to obtain supplementary certificate additional to his basic qualifications in

(Photo: Peter Ekin -Wood, Eastbournel

such subjects as Occupational First Aid, Am bulance Attendance, and Home Nursing. The latter is almost an essential qualification for a full-time first-aid attendant.

These are the people who should be trained to provide the continued treatment of minor injury. It is, of course, vital that at the same time they are taught to realise their limitations and to recognise the likely pitfalls.

The advances in medical science in the last two or three decades have so enhanced the prospects of the seriously ill or injured that the contribution which the doctor can make to the early management of casualties at the scene of injury is becoming increasingly apparent.

The growing number of general practitioner emergency care services is evidence of this.

Consideration should be given to the management of the serious coronary thrombosis. There is a place for the doctor or the specially trained nurse in industry to collaborate with the local intensive care unit in the provision of some of the emergency measures recommended by the local unit before and during transit. One coronary care unit (Salford) at least has under active consideration the making of its flying squad, at present turning out only at a doctor's request, available for call-out by nurses or specially trained first-aid attendants in local industry.

The training of medical and nursing personnel in first aid has in the past been grossly neglected. Fir'st-aid is at last, however, being introduced into the nursing and medical stud en curricula largely as a result of the work of Medical Commission on Accident Prevention, who also encourage student participation, for example, in the manning of emergency ambulances. In spite of these advances one views with concern the great reluctance, especially of the newly qualified, to work in Casualty Departments. Here one learns about people, about the effects of recent trauma and acute illness, in a way which is impossible elsewhere. Here one can practise one's own first aid, and assess the knowledge and quality of the first aid already given to patients before arrival.

Six months' work in a Casualty Department should be a requirement of any post-graduate job or qualification, and in particular for any post as an industrial medical officer.

The following recent experiences helped to formulate some of the thoughts expressed in this arhcle.

A newspaper described the case of a young man, who collapsed unconscious at lunch time in a club. He was carried home by his friends and placed on his back on a settee. At the inquest the family described sitting watching him snoring away whilst they awaited his recovery from an apparent alcoholic 6

coma. Three hours later he suddenly stopped breathing , and at a post-mortem the only abnormality was an airway blocked by food residue.

A car a few hundred yards ahead crossed the central reservation of a dual carriageway and ran into a wall. When the scene was reached the driver was being treated at the roadside for a cut head and the two children from the rear eats already in a road ide cafe being resuscitated with ice-cream. The mother was sitting in the front passenger eat unattended with her head collapsed on her chest, cyanosed and with obstructed breathing. Fortunately this wa no more than a vaso-vagal attack, for when lifted from the car and placed in the three-quarters prone position, she recovered almost in tantaneou ly.

A small depot employed 30 men, an elderly female typist, and a IS-year-old girl messenger. When the first-aid man was congratulated on hi Llcce s in passing his examina tion, he asked to be taught hand and finger bandaging. On the course whi ch he had attended the only bandaging he had seen was with the triangular bandage, or as he more suc.cinctly put it, 'They laught me all about emergency child birth, but didn't show me how to put a bandage on a finger'

In the week following major motor way pile-ups, two heavy goods vehicle drivers independently approached nursing sisters to ask for information on what to do for a trapped casualty. This demonstrated a need for instruction and assistance which should have been foreseen.

BRINGING FIRST AID TO THE PUBLIC

The final illustration comes from a recent 'Tomorrow's World' BBe tel e v lsi 0 n pro g ram me, w h e experimental arrangements for the care of serious or mul tiplc casualty sItuations in Germany were demonstrated. A mobile operating theatre sLlspended frol11 a helicopter was transported to an autobahn so as to provide optimum faciltties for examination, first-aid, and if necessary, immediate treatment. Whilst this fuluristic concept of emergency care may have 11ll1lted application in a small built-up country such as Britain, it could well play its part at major disa ters. In addition it demonstrates the use of the helicopter 111 tile quick transport of men and equipment to places of need, and the possibilities of helicopter evacuation of casualtJes where remoteness in distance or in time mean that the more conventional service" would be seriously delayed. ThiS could well be the transport of the future, bringing aid to the informed member of the general public holding the Jaw and maintaining the airway of a seriously injured casualty and praying for the arrival of expert assistance.

REFEReNCES

MILES, S. (] 969). British Medical 101//'1101, 4, 485. '\[A "JL AL or CAR DIo-peUIO AR)

RES U S (' I T A TI O"J (1968). \\ 0 rld Federation of SOl'lelie'i of Anacslhesiolo21 \1EDICAL C0\1\1ISSION 0'\1 ACCIDL PRLVE TIOt\J A UAL RLPORT 1970-71, p. 23. WARD CARD"J[ R A. and ROYLANCE, P. 1. (1967). 'Yew Esse/ltia! First Jlid, p 18. Pan Books.

Jungle First Aid

A ST. JOHN MEMBER

IN PANAMA'S DARIEN GAP

by Mjr. K. R. Morgan-Jones

I THI K It was Dr. John son who said something like' o-one concent rat es on detail so much as a condemned man' I have never had such an attentive audience as I had just before, and during, the British Trans-Americas I--xpedition. Reader may have been aware 01 this expedition dunng it progress down the length of North and South America. Two Range-Rovers were driven by members of the 17th /21 st Lancers along the roads of these continents from Alaska t o Tierra del Fuego. In one area, where no vehicle had penetrated bdore, the Jungle rresen ted a forl1lluable harrier to <lny form of progress, which I usually only made by canoe down orne of the larger river About sixty of us, oldier and civilians (including five ladles). arrived there in Panama to aid these vehicles through the Darien Gap, the two-hundred-andfifty-mile stopper of ailiancl transport. It was early January when we arrived and took tock of our party. There were engineer (Royat ones, or 'Sarpers'), zoologists botani ts, a geologi t, a SOCio logI st, an author, hor e wranglers (female), infantry soldiers, evera jacks and three jills-of-all-trades a nurse a doctor, a dentist a nd a As th'ese jungle aspirants were to be caltered over an ,Hea of between one and two thousand square miles, the medical potentIal was a bIt thin.

A base had to be set up in Panama to receive the sick and convalescent. The plan was that Sue Ri chardson (ex-ward sIster of St. Barth o lomews Ilo sp ital) should lo ok after thi s part. lIer husband Capt. John Ri char d son RAM ., providetl th e professional cover on the trail and the expert advice when he himself was not physically present poor soul, he went down with some indeterminate ailment

Evacuating Rosemary Alhusen on an improvised stret c her. Author holds rear of st retche r himself for eight weeks, but fortunately for us did not lose his powers of speech and could communicate one-way, at le ast, by radio. Major J ames Beattie RADC was a subsidiary doctor, as was 1.

When, in 1968, I was veterinary surgeon to the Great Abbai (Blue ile) Expedition I had a lot of human treatment forced on me by circumstances. Until then [ had no specialist knowledge of human medical practice and relied on the common knowledge our overlapping fields of mediclne enjoy. I was determined not to be caught out again without the rudiment at lea t.

I wa mo t fortunate in my last military rosting, a non-veterinary one on the General Staff in Wal es, to be asked by Lt. Col. L. F.Q. Maclain e, RAMe the then Commissioner for Breconshire, if I would undertake the organisation of Association activities in the county. I readily accepted and made it my first task to acquire the knowledge that I wa to encourage the various organi ations and institutions of Bre conshire to learn. Whil e cIasse begun, I obtained my own fir aid and home nursing certificates. I also became a lay-instru ctor.

Then' were a few first-aider already among Ollr expedition member. They were ;) gold to the hierarchy of the expedition and espeCIally to its leader, Major John Blashford-Snell. To overcome the shortfall then, ( undertook to take a' man) members a' I could in a crash cour e in elementary first aid.

In the preparation phase, when we were temporarily housed in a Panamanian infantry barracks, I had the ideal facilities for lectUring A cla sroom, a black board and chalk. I was thu able to bang home the first ix lectures of the cour e and to i sue all students with a triangular

bandage each. I will not list the uses to which a lot of the bandages were put, but at least some got onto human patients, and who was I to comp lain when a few of the horses turn e d up wearing them on various cu ts and injuries

The remaining lectures I managed to deliver piecemeal to groups in the jungle. I used the old manual, i.e., First Aid Second Edition, Second 1969 Impression, and the Anatomical Atlas (Transart o. 2) which is the best 2Sp-worth I have ever had. Take sixty people and scatter them for four months in some of the most hostile territory known to man and there will be many significant incidents. I will not list them, save to mention a few of the more spectacular. We had our suspected appendix case, the horror of small groups of explorers. We had our fractures, a lot of sprains and strains, cuts and bruises, infections of a local and minor nature (we had been immunised against all the major horrors). Poor Rosemary Alhusen collapsed with an anaphylactic shock after reacting violently to a hornet sting. This was a good lesson in the value of getting the patient's legs above the level of the head, for Ro emary recovered very quickly after she had been carried in this manner for some way.

I think the first aid training of the expedition wa an overall succe o-one died this time; nobody, hitherto, ha been permanently incapacitated. I believe that a lot of suffering was alleviated, if only with the soothing of cuts, bites and cratches. But I al a believe that much reassurance wa given through the confidence obtained by that initial conce ntration on detaiL before tho e of us voluntarily condemned to the jungle set off.

(Photo: The Windsor Express)

AWARD

The following letter from the Chief Commander was sent recently to the St. John Ambulance HQ, Guernsey:

I am delighted to inform you that the Order of S t. John s Life Saving Medal in Bronze has been awarded to Transport Corporal Roger Blanchford in recognition of his gallant rescue of Richard Le Galloudec at Petit Port, St. Martin's, Guernsey, on February 26 1972 ; also that as Commissioner-in-Chief I have awarded the enclosed Letter of Commendation collectively to the supporting members of the rescue team

Please will you convey my warmest personal co ngratulations to Roger Blanchford on this well-deserved award and also to his father, Area Commissione; R eginald B1anchford, on having trained his team so superbly, and arrange for the collective Letter of Commendation to be presented on a suitable occasion.

CASUALTY EXPE RT

A Stevenage man who founded an organisation which now has branches all over the world, has become President of the Stevenage Broadwater Combined Division He is Mr. Eric Claxton who until his retirement was chief of the Stevenage Development Corporation. It was more than 30 years ago, when he was actively involved in training war time civil defence workers, that Mr. Claxton had the idea of forming a group whose members would bring realism to casualty simulation. As a result of his efforts Casualties' Union came into being Now it has branches all over the world with members who will fake anything

AROUND anlABoUT

WHAT ' S GOING ON IN THE WORLD OF ST . JO H BY THE EDITOR

from a headache to a heart attack, or a grazed finger to an amputated limb.

Within days of being appointed as President of the Broadwater division Mr Claxton heard that The Queen had roved his appointment as an officer in The Order of St. John. 'It was quite extraordinary,' he said. 'T he two things were totally unlinked and since I consider both of them a delightful compliment they really are very warming to me.'

HONOURED

In ·addition to the New Ye ar Honours for St. John service mentioned in AT RANDOM last month, we are deligh ted to hear that Mr. A. Mayhew , Brigade County Secretary for Essex, received the MBE for his welfare work with the firm of Constructors John Brown.

STAYING POWER

The Salvation Army's Captain Olg ar Pickles, an ex-SJA nursing cadet, returned to her home in Halifax recently after 5 years in South Africa

She qualified as State Registered Nurse

APPOINTMENTS

HQ: Miss Lucinda Romilly to Ass. Supt-in-C.

Cambridgeshire : Mrs. Vawser to be County Supt ( .) Vice Mrs. Manley.

Cheshire: Mr. B. Harrison to be Comm. E. Area.

Cornwall: Dr. G. F. Barnes to be County Surgeon.

Devon: Dr. A. Everard to be County Surgeon.

Essex : Captain M. Bendix resigned as Comm. S. E. Area

Kent : Mrs. Mercer (only woman Area Commissioner) to be County Supt. (N).

Leicester: Dr. A. R Bradley to be County Surgeon.

Notts: Commander A S. Mortensen, R , JP , to be C. St. J. A.

Surrey : Mr. J. M. Ball relinquishes Comm. W Area on transfer to the Reserve.

Sussex: Miss ( Dr.) E. L. M. Perki ns to be County Supt. ( ). Warwicks: Sir David Watherston C

St. J. A. to be Chairman of Council in addit ion.

India: Lt Col. P. Bhatia retired as Dep. C-in-C. 0 successor yet.

at the Roy al Free Ho s pital in Lond e became S ta te Certified Mid wife at t Mothers Hosp ita l also in Lond on a! became a State R egistere d Fever urse the one-time isolation hospital orthowram Hall, Halifax.

In August 1967 this dedicated worn who had been told that she wa n strong enough physically to be a nur

Ex cadet CaPtain Olgar Pi ckles. See STAYING POWER (Photo Evening Courier, Halifax)

sailed to Capetown and began a new life in her profession. She served a few years at the Booth Hospital as a sister then as need arose she moved to orth atal to the Mountain View Hospital. Here the whole mountain was administered by the Salvation Army school, village and hospital serYing the local Zulu people.

Here she worked in the midwifery department. 'Expectant mothers came to live in small , round huts in tJ1e hospital compound for at least two or three weeks before the birth of their babies,' she says. 'Each day they put out their food bowls and the needs were supplied by the ho pita!.'

[t was difficult, however, to gain the confidence of the Zulu women and therefore Zulu nurses were trained as a better means of helping the patients.

From this hillside hospital, Captain PIckles again moved. This time even further into the Zulu outback. Through cane field and mud t rack she travelled to the Catherine Booth Il ospital, at Amatikulu.

most efficiently.

The Bantu Trust supplied an ambulance but there remains the need for a new outpatients' building. With Salvation Army funds augmented by Oxfam and the Bantu Trust, it is hoped that a midwifery block will be built.

At one time they had told Capt. Pickles that her health could never stand the strain of nursing. She had been in the St. John Ambulance Brigade cadets, but when she went to train as a professional nurse, she was rejected.

She went to work in a mill, then as a hospital orderly and indeed found that on health grounds she had to give up the work. She worked in an office.

'I liked it better than the mill,' she later said, but it was not what I wanted.'

She went again as a nursing candidate and again was turned down. Then two years later she received her chance at Northowram Hall. 'Right from the word 'Go,' I loved it,' she said.

It was a proud day when she was presented with a rose bowl trophy as the outstanding nurse of her year.

FILM TAPE

The producer of the 16mm film 'The Order of St. John' (which may be pur-

Area Co mmissioner H. G. Hemming thanks Crewe Lions Club President Mr. John Bailey for the r e c 0 nditioned ambulance the club presented to Crewe Am bulance D vision. R esus cit a tion equipment, preViously presented by the club, will be used in the ambulance

nty Staff Officer B Tyler (Mr. Tyler's 94-year-old father used to use the litter for bringing patients into Northampton) is going into the Northampton museum

This hospital is supported by the Bantu Trust. Two doctors work there but there is no theatre, X-ray department or laboratory, and all serious cases have to .sent to a distant hospital. Outlying ClllllC are attended weekly and patients are taken to where they can be treated

chased from HQ at a cost of £100 per copy) has prepared an introduction to the film on tape; this tape, which may be played on a normal tape recording machine, has a running time of 8 minutes and plays at the speed 7V2 ips. This introduction sets out the film's objectives, and suggests many ways in which the film may be employed. It is accompanied by a typescript and costs £5.00 per tape from The Secretary, Visual Aids Committee, St. John Am b u I a n ce, 1 Grosvenor Crescent, London, SWI.

H E LP O FFERED

The St. John and the British Red Cross Society joint committee for ex-services war disabled, through the ursing Section of the E.W.D.H. Department, can give help, subject to the equivalent of six months full time war service, to the following:

(a) Ex-nursing officers (State Registered urses) of the following services, having served in either World War or any of the recognised subsequent hostilities: Queen Alexandra's Royal aval ursing Service and Reserve. Qu een Alexandra's Imperial

Bristol's F ilton Ambulance Cadet Division were recently presented with a Transit van by Rank Xerox Ltd. Div. Supt. A JOiner, 239 Church Rd., Frampton Cotterell, BristOl, wants to hear from anyone with plans for conv erti ng th is vehicle.

(Photo: Bristol Evening Post)

Military Nur sing Se rv ice a nd Re se rve

Que en Al e x an dr a' s R oya l A r my Nursing C orp s a nd Re serve

Pr in c es s Ma ry's Ro ya l A ir Fo rce

Nursing Servi ce and Re se r ve.

Territ o rial Arm y N ur si ng Se rv ice a nd Re se rv e.

Orde r of st. Jo h n a nd British R ed Cross So ciety

( b )

VAD offi ce rs and m em b e rs of the 19 14-1 8 War.

VAD o ffi ce r s a nd m e mb ers w ho s erve d wi t h th e Arm e d Fo rces of th e C r o wn n he 1939-45 war or

re co gn i se d su b seq u ent h ostilities.

Offi cers a nd m e mber s of S t. J oh n

Amb u la n ce D iv is ion s, a nd British Red Cro ss So c iety De tachme nt s who nurse d in t he 193 9 -45 war ,

Looking after the boys

ment are attached to military hospitills throughout the wor ld.

This report comes from one oj' them Mer le Melford-Colegate, who is senior welfare officer at the British Military Il ospital, Munstcr, Germany: at incc Woolwich days have I had to uea! with the blind or temporaril y blind as in the case of one of Ollr patients, a so ldier from another part of BAOR.

The patient , after an eye operation in a nearby GermJn hospItaL was back to BMlI to spend three or fOll r weeks on his back, with his eyes bound up, only able to use hIS hands.

Even with the assurance that hIS sIght would return, our young oluier was frightened , bored and restless

St John and Red Cross Senio r Welfa r e Office r M iss M e r le MelfordC olegate solving p r oblems in a military hospital In Ge r many. See PR OBLEM SO L V ED

i n clu d ing those who served in the Civil Nu rsi n g R eserve.

H e l p avai lable under this section is not confined to those suffering a disablement attributa bl e to or aggravated by their war service, but covers needs incidental to sickness, age or disablement. In some cases a periodic grant may be made to ena bl e an aged nur e to pass her latter d ays in co m fort.

Sh ou ld you know of any eligible exnurse in n eed, will you p lease send details t o: T h e E. W D H Department, The Order of St. J ohn and the British Red Cross 6 Gr osvenor C rescent, London SW I X 7EH:

PROBLEM SOLVED

We lfa r e officers of the S t. John and Red C r oss Se rvice H ospitals Welfare Depart-

[AT RANDOM (continued from page 1)

are found to be suffering from an illness for which there is no reasonable expectation o[ cure. There is a very real place for members of l. John 1\ mbulance in such a 'caring team': some, I know, are invo lved already: but l'm sure that fuller information will encourage others to share in thIS immensely worthwhile form of service to mankind.

are notable exceptions; but however thankful we are that these exceptions exist, they serve, alas, to highlight the inadequacy of the remainder.

It was a double

THE TRIANGULAR B ANDAGE

We tJlked Ilim out of his anxiet) relieved his boredom with a wire less, bllt found his restlessness mLlch more difficult to deal with, [or obvious reasons. In the end, I went into a toy shop, closed 1m eyes and felt all thc puzzles and games' it came to me in a flash all was clear J\ my hands fastencu on Lego, the plJstll building game. Lego consists of rectang· ular pieces, the pieces with a raIsed pattern fitting II1tO the ones With a concave pattern, at once apparent to the touch, with limitless permutJtions, I.e car, houses, trucks, bridges, etc.

We had solved our problem ou' patient played with his Lego [01 tht whole time he was in here, and was quit. happy.

FRANK FREWIN

[ n the obituary notices last month the late Frank Regl11ald l-reWl11 of Londo n District was listed a, corporal. 1r. FreWI n Joined the Wimbledon Di\ision in 193 and was a corporal, but from 1956 he wa on South-West Area staff and Am Training Officer for most of that time. H was made a Serving Brother in 195 I and an Officer (Brother) in 1972.

was asked the other ua) If I knew the origin of the triangular bandage. bec<.luse It seemed such a brilliantly ingelllous invention \nd I said 'Ye<;: and \\-hat's more. I can show you a picture of the original 1 hat's not strictly truc, becJuse I believc it wac; first Invented by J Dr. \la) or of Lausanne In 1831, but his idea never caught on. 11\ ' re-invcntion' twenty }ears later was uue to the resource of a London policeman and the ingenuity of a German uoctor. When the young Dr. Fril'driL'il von Esmarch was VIsiting London to sec the G rl'at I.: Xhlblllon In 1851, he saw a policeman who doing fir!:>t aid at ,I accident pull out hi handkerchief and, folding It into a triangle, use it in this shape to keep a dressing on a wound. 1 hIS gave the doctor an idea, and on his return to Gerl1lJn} he experiml'ntcd WIth different ways in which a triangular piece of L'ioth (Ia rger than a handkerchid) could be used for slings and to keep dreSSIngs and splints in position. In 1868, by which time he become Professor of Surgery .It Klel University and \\,IS soon to be urgeon-General to the urmy, he made an engraving showing a SCl'ne at a front line dressing sLltion, with casualties bandaged in such J WJY as to demonstrate the vanous uses of his new triangular bJndage: Jnd he had it printed for purposes on triangular pieces of linen, thL' Sill' of a square metre cut clwgonally in half. Thi becamc the stanLic1fd fornl of handaging taught to the Prussian Army MedicJI Corps, Ils fll'st extensive use was during the war of IH70. or two later IIRII Princess Chl'istian, a daughter of Queen brought some of these ovcr to L ,Ind tilus intlOLiuceu triangular bandaging, as wt' kn ll\\ ii, to thL' l'ountry where, ,lbout twenty year, bcCore, ,111 unknown LOl1don 'boblw' had first so\\n the seeds of tilc idea l'he photograph :Ibovl' one of thl'''t' bUnd ,lges whicil WdS given by Pril1l'l'ss Chll,ti.111 to myoid I'nenLi the Llte Supt h 'l'll Sil11mond.., of the Royal Windsor ,\ l11buLlI1cl' DIvision. And II always Ihnlls me to "ee from this photogr.lph that in just over a cL'ntm) we have found little CIUSL' to alter or on the methods of b,lnLiJglng tilat Dr. von Esm:lrl'il Invented.

FIRST AID IN SCHOOL S

I sometimes hear III or read in the press, Complaints about the lack or aid 'cover' for aCCIdents that Illay OCCur in of our schools and L'olleges Of course there

ot long ago I was talking to a Brigade member on the staff of a technical college with more than 1,000 pupils So far as he knew, he was the only person on the premises who possessed a valid first aid certificate: and though this was not part of his professional duty and in no way officially recognised, he was always the person called in when an accident occurred. On one occasion a casualty who should have been kept at rest till proper first aid had been given, was brought to him from the far side of the college grounds: fortunately, the consequences of the journey were not serious, but it's easy to think of cases in which such a journey might have gravely aggravated the casualty's condition a nd perhaps even proved fatal.

Injuries in the playing fields, the gymnasium and the swimming pool may well be covered by the presence of PE instructors who qualify in first aid as part of their training. But there is no guarantee of their qualification being up to date. In very few schools is any encouragement or incentive given either to sta ff or to senior pupils to learn first aid. Yet a modern comprehensive school has (apart from its PE activities) a potentiality for accidents in its science. metalwork and woodwork departments which are at least as great as in some factories, shops and offices involving comparable numbers of people: but it does not share with these establishments the statutory obligation to have trained first alders on the premises. From my own past experience I can vouch for the immense value of having - over and above an efficient and well -publicised accident procedure a certain number of both staff and pupils who voluntarily underwent first aid training, and the number of occasions when they were able to be of service both to the school community and to the general public wa very con iderable. I hope that any of } ou who happen to be either school governor ' or teacher or parent of pupils or. indeed, senior pupil will u.e your tacfful influence to encourage fir t aid training in school' and improved condition of fir t aid 'cover' in tho e 'c hools where it is below standard. A development on the. e lines would not only benefit the schools but be an immen e ervice to the community and I'm sure that it would also bring in ome new recruit to the Brigade!

FELLOWSHIPS

Last September I gave details in this column about the Travelling Fello\\ship offered for 1973 to our adult population (mainly through profe sional bodie voluntary organi ations) bv the Winston Churchill Trust. The Trust recelvcd 12,000 enquiries and 3,999 firm applications, and 99 of these applicants were 'elected Churchill Fellows.

We ila\ e no sure llle,1I1S Jt Headquarter of identifying those who have a t. John connect ion, but we have spotted tince, each of whom will be spending a 2-month period o\er.eas, and we should be very grateful to hear of any others. Ir. P. G. Bowen (Di\ i ional I:.pping Combin'ed Division. und Hospital cerdar}, t. I\largaret' Hospital, Epping) will study the ambulance services and their links with other public sen ices and hospitals in Germ.lny. Denll1Jrk and \\eden: 1r. I I. E. BmtenshJw (acting \ SO, South Eastern ,\ rea. London District, and a Customs Oft::-il'er) will study ambulance services and disa ' ter procedures on the continent: and I f. W. R. (formerly a St. John Cadet at !\e\\'hav n, and now a member of the East lIssex Ambulance Sen ice) will study the operation of sen ices in Australia, \Je\\ Zealand anu Hong Kong. We congratubte them ,III and wish them the best of success in their ve 11 t u res I 1

ADeath in the Family: A Professional View

by Cicely Saunders, OBE, MRCP

(see A T RANDOM p.l)

I 0 CE asked a man who knew he was dying what h e looked f or a bove all in the people round him , and he paus e d a moment and then he sa id , 'For someone to look as if they are trying to understand me He did not ask for success. He aske d for the effort of trying. Th at is why we are all here today, and we have ahead y been brought right into the centre of the situation of the patient who is dy in g an d his family. We a re beginning to try to understand, and I think I can best continue by sharing some of the things we have been trying to underst an d at St Joseph's and S t. Christopher s and other places as well. Above all we try t o allow our patients to speak for themselves.

So often people are just not prote c ted from the truth that you think you are protecting them from ; they are left alone with it instead I remember sitting down with one particular patient and sa ying , 'How are you settling in?' He sa id , ' J don't know if I have time. think it 's a little wooden box.' He wanted to talk, and then he tucked it away again. On the record a few days later talking to one of the nurses, he said, 'Of course it's just my rheumatism, I'm really not too worried. '

The patient and his family are often separated by unshared knowledge I remember one man talking with me about the 18 months after his first operation when he could not think what h a d happened to his marriage. There was some b arrier between him and his wi fe, and he did not know what it was until eventually he had a recurrence and he tackled the doctors. The doctors, see ing the person, the man, behind the questions , then told him and he and h is wife were able to share the trouble. And [ remember asking him 'Back at the beginning, would you rather that you had been to l d more , or that your wife had b een to l d less?' He said 'The second, but whatever had happened I would have wante d to share They did corne together, and they stayed together.

The Patient and H is Pain

I h ave been asked to talk about th e patient and his pain , and I think this is 12

Dr Saunders trailled as a nurse and social worker before stl/dying medicine in order to 1V0rk with patiellts with terminalmaligllan{ disease. Her par ticlllar concerns are with the ullderstanding of the patient's emotional alld spiritual problems alld those of their families, and the control of physical pain She has wo rk ed ill this field al St Joseph's Hospice, Hackney, and elsewh ere since 194 8, and more recently she founded S t Christopher 's Ho spice, Sydelrlzam, which was opened in 1967 and of which she is now Medical Director

very important at this stage. If we are thinking of the things that separate the patient f r om those around him, certainly pain can be one of them. One patient on admittance, sitting boll upright with tension, was separated f r om his wife with her terrible feelings of inadequacy as if by a solid wall. H ome had become impossible just because of pain. By r elieving that pain , we were able to bring them together, so that they were more together afte r he was admitted than they were when they were alone a thorne. More outpatient facilities so that this could happen at horne are, I think, one of the most important development s ju t beginn in g in terminal care at the moment.

For some patients , however, pain is some thin g that is so all-embracing that it really ca nnot be coped with adequately all the time at home C h ronic pain an apparently endless situation, who se meaning is r eally on y one of threat. One patient painted a vivid picture of this kind of pain, but after a short period, by control of infection and the use of s ter oi d s, pain was co ntrolled. The point is that you can r elieve pain so that a person is himself. To be ab e to go to the heatre t wo night s be fore y,ou die is the kind of thing we shou ld have as our aim, wherever it is p ossi bl e So much pain can be relieved without resorting to a n a lg esics. The doctor mu s t sit and li sten to the various facets of distress so th at he may see whenever something s pe cific or some new adjuva nt can be introdu ce d Nor d o we need to employ large do ses if drugs are given r e gularly. The maximum d oses needed by

this cup of tea comes best of all from someone who ha s co mpa ssion, un d ers tan din g, and practicality someone W)lO docs add heart to kill and has a sense of meaning and assurance of another dim ension in life. We should never impose our own beliefs and own feelmg of meaning on to another person, but I am quite sure we could help produce a climate in which the patients can find their own meanings, and can find the quietness and dignity of death as it can be when it is a person not the apparatu!'> around that is the centre of attention.

the maj ori ty of our patients are not high. Out of a total of 500 patients 428 were given diamorphine for control of Only 19% ever needed more than 20 rng at a time.

I nvolving the Whole Family

If the patient has to come into hospit al I do think it is of enormous importance that the family should feel as if they come in as a whole. Sometimes one enables people to meet agam. One family I remember was reunited in tillS way. The sons met their rather when at home they had been refu ing to speak to him, resentful and uncomfortable with the illness of which they were so frightened: the fits, the s tr angeness. And in the ho!'>pltal atmo phere the wife and the mother-in-law also began to be able to talk and work through some of their feelings. Rather later in this patient's illness, not very long before he died, he enjoyed the sort of visiting that one wants; like one's time together at home, the family just sitting reuding the paper. the wife knitting, the informality and being relaxed. Tha t wife was a ble to wash her husband and do a lot of things for him in the ward. We know something of this family and the stresses of their bereavement. The boys got ver) aggressive with each other. One thought he had a ce rebral tumour and the l1l"ther, now a widow, had to ca ll the doctor in the night. But now one is married, one is in the Air F o r ce. Jnd the third, having f..llled his 0 levels at the time of his [ather's illness, has tak en them again and passed. As for the wife, she has been coming back to us as a volunteer.

Children sho uld visit, should be involved, shou ld be part of what is happening. But to do that we must be a bl e to contro l pain; it must be the father th ey know. And in doing thi s we have to learn when t o stop doing our pro longation and when we accept that this is a peaceful death and s hould be a ll owed to happen. It is far better to have a cup of tea on your last day than dops and tubes in every direction. And I think

Finally, I remember a patient not with ca n cer but with motor neurone disease, a police sergeant who died aged 39 after 2 to 3 years of illness. remember his saying at an early stage, If I thought I'd ever be like that chap I'd do somethll1g to myself.' But when he did reach the stage

that he had heen watching he found that, frolll in side, the situation was very different as long as he was not alone. We often discllssed talks such a this and he once offered me a title, 'Bringing-together Illn ess,' in preference to the phrase 'Catastrophic' or 'Terminal' which I had been given. I said, 'Do you always see this 'bringing-together' happen'?' He said 'Ye , I am a trained observer and I'v e been here for 18 months. Pati ent and family, patient and staff, patient and patient yes It does happen .' And he went on making this more true to himself up to the very end. I remember his saying 'I can't see round the next bend but I know it'll be all right.' What we have to try to do, think, is somehow to help the dying patient and his family in every possible way to find this kind of security. The world in which your own body is letting you down, and the world in which

so m eo ne has left you, feels and sometimes is a very unsafe place. But this situation which cannot be changed can be transformed. The demands of the family are in many ways the same as those of the patient. They do not need just sympathy and sedatives, but something that was summed up for us for aU time with the words 'Watch with Me.' I think that phrase means listening without necessarily knowing the amwers, and persevering with the practical, which includes developing skills. But above all it means do not forget to be simple; be prepared just to be there. We must somehow give everything that we can to these people that says 'you rna tter becau e you are you,' everything to enable the patient to live up until he dies. and the family to go on living afterwards. Reprinted from the British Medical J ouma!, 1973, Vol. I, P. 30.

Operation Ugandan Refugees 1973 FINAL REPORT

o AUGUST 14, 1972, St. John Ambulance offered help to the Hom e Offi ce in the reception of the Asians expelled from Uganda under General Amin's decree. On August 21 a St. John representative attended a preliminary meeting at the Hom e Office, at which the formation of the Uganda Resettlement Board was announced. Sub equently it was agreed that 1rs. Clode, Chairman WRVS, shou ld represent both St. John and the Red Cro s on the Board, so that throughout the emergency there was comp lete liaison between the three organisations as we filled our respective roles.

Role of St. John Ambulance Ambulance and nursing members assisted in this emergency as follows:

At Airports At Stansted, Heathrow and Gatwick members worked in shifts as required to meet the immigrants of[ the plane. They helped the elderly, the dIs a bled and the women with children with baggage, and provided ambulance or wheelchair transport where needed.

The Asians were then accompanied through the medical screening and d oc umentation process, and escorted to the WRVS canteens and clothing s tores. Together with the Red Cros fir t aid posts were manned and baby-food and nappy services provided where these faci l ities were not available at an airport.

In Transi t : St. ] ohn members spent

more than 2,000 hours escorting the bu es and pecial trains carrying immigrants from the airports to reception centres, and sometimes between r e c e p tion cen tres. This task often involved a night away from home and was particularly tiring, but the pirit of the Asians and their fortitude throughout a much longer ordeal won everyone's admiration.

At Re ceptio n Centres : At the reception centres our members Joined with the Red Cros and WR VS in the preparation of the accommodation before the Asians arrived, with pecial reference to the fir t aid and medical centres. Thi often involved cleaning as well as equipping the q uarLers.

On arrival, the immigrants were met, and accompanied through medical

screening to be ettled in their rooms. Thereafter members were on duty at the medical centres, sometimes helping the medical officers and S R s in the sick bays: they also manned with the Red Cro s fir t aid posts where these were set up. The elder!) and sick were visited in their quarters, prescriptions were fetched and distributed, and in several cases our local ambulance were on call. Baby food and nappy ervices were provided. Later, as the immigrants settle d down, short first aid and horne nursing classes were tarted to help them in their future homes.

Vetting of Priv ate Accommodation Offered: Member all over the country helped in thi ta k.

Total hour completed on the above duties were 26 ,638 13

A typical scene at Sta nsted Airport during the operation

Cadet Jubilee Roundup

CHANNEL ISLANDS

Am bulance Cadets in Guernsey have broken new ground by W.lY of comnh.'l11or;Jting the Golden Jubilee fwo have qualified as I3riti.,h ,ub-Aqua Cl ub snorkel Jwarli in\trudors <Inti e'<,ll11inel\. Putting their qu,llificatlOm to good ust'. It was not long before three cadets g,lincd B A Club cer ti ficates for swimming and primary tesl'>, entitling them to we,H the snorkeller emblem. I h e flr"t ollth group In Guernsey to tilke part 111 the scheme they believe themselve'-o to be the fir,t members of St. John Ambulance to gain these aw.lrds. rh ey .Ire .III members of Guernsey I11buLtnce Cadet DI\ision. The Rohdis up,lng Cadet DIVision ill Guernsey decided to give extra ,>er'l-iL'e to e ld erly people liuling Jubilee Year. I he\' set to war" knitting and crotcheting brighll:. coloured squares \\ hlL'!t Wl'fe made up Into blan"eh. shawls. cushion and hot-water bot til' L'O\c[S. r he\L' wcre presented to the Pr esilknt of thL' \ 'IL'lOrIJ Jlom es, Mrs. Poal.

SURREY

\s a contribution to cadet Jubike Year, the Surrey Divi Ion,> In the Dor"ing subarea held an opL'n competition not onl) in fir..,t aid and nur,>ing but in other cadet

proficiency as well. The Dor" ing urban di strict council home committee promoted the event, which was h eld in the sp<lcioLls f)orking Iialis 20 cadet teams and 6 junior teams took part, and the object of the exercise was to run a cOII1petition with a difference The experIment of including simple tests for Sl. John junIOrs proved very s Liccessful , and inter est was added by including te sts in child care, ambulance loading, camp ing and h omecmft. The proceedings s t arted with a short service, and while cadets wailed to compete they were shown films Teams allending th e competlLJon carne from Sussex, Hamp slllre and Surrey.

WEST COUNTRY

At Brist o l on September 30, cadet teams from the seven cOlInties of O. 7 Region compe ted in a swimming gala. Of the six inter-county races, the Devon team look four fir'its and one second in the five races they entered.

(left) presents the special Golden Jubilee certificate to Aldershot Ambulance Cadet Division, the oldest SJA ambulance cadet division.

(Photo: Aldershot News)

I

Guernsey: (left) Rohals nursing cadets present their gifts to tile preSident of the Victoria Home s. (Above) Acting Commissioner Mr H Touzer (centre) pre sented sub aqua awards to Cadet Leader Andrew Osborne and Cadet Corporal Douglas Ie Fevre (PhotoS. Guernsey Pre ss)

Worcesler Nursing ca dets (R) with () viSiting tea m of cadets from Goppingen, West Germany, who com peted together in a first -aid

mpetit

n at Worcester recently Seated (L to R) are Dr Clark, Herr Bruno Kirchgessner and Mrs. Field

London District /West ern Area cadets gave two performances of Dick Whittington just before Christmas as part of jubilee year. The cast consisted of 48 ambulance and nursing cadets.

(Photo: Middlesex County Press )

SJA Devon 's highly successful cadet teams at the Bristol swimming gala See report WEST COUNTRY (Photo : Roy Barnes, Dartmouth)

Training our Leaders

THE ART OF EFFECTIVE SPEAKING : PART 1

Characteristic s of an effective speaker

WHA T are the specific characteristics and personality traits of the type of speaker to whom we enjoy listening?

1. First of all, he is a person who is wide awake mentally, emotionally and ph.1'sicaUy. He believes that what he is saying is worth saying, and that it is worthy of the listeners most concen rated attention. His chief concern is to think and act in such a manner as to cause the listener to react to the ideas presented - a he wishes them to react.

2. He is thoroughly informed 0/1 his subject He is a diligent reader, and thus makes it a personal affair.

3. H e is deeply interested in his subject. He manifests this interest by becoming a n imated while he speaks.

4. He is a c ear speaker. He knows what he wants to say and he says it in a simple straight-forward manner. Becau e he is clear in his own thinking, he never confuses his listener with inconsistent s atements, irrelevant material, long and involved sentences or through the misuse of words.

5. He possesses a strong imagination. It is easy for him to visualise realities wh ich cannot be physically exhibited under existing circumstances; thus he is able to paint word pictures which stimulate his listener to form mental concepts.

6. H e has a good speaking voice. It is agreeably pitched, adequately strong and rich in quality. H e speaks clearly and distin ctly. H e fits his rate of speech to the need s of the material he is discussing; following the basic principle that the most important material requires a slower rate. He secures audience attention through the use of his voice.

7. H e has control of his body. He makes i se rve as a medium through which he expresses his ideas more effectively. He uses movements for the purpose of e mpha sisin g the ideas expressed in words. He co-ordinates his thoughts and his movement s.

8. H e selects his words carefully. He co nsid ers them from the standpoint of both meaning and sound. He appreciates 16

This arricle, pllblished ill tlVO parts, 011 effecril'e speaking is the basis of traillillg employed by i !mericall State Police alld was prepared by Ih e Los Allgeles Coullty Sheriffs D eparr 111 ell 1 Traillillg Bureau. It was sellt to liS by SIA's Hampshire Deplity COli II tl, Commissioller H. hi. Harris , who lVas Traillillg OfJher of I falllp sliire COl/stahl/larl'.

the psychological effect of certain sounds upon his audience. fn the best types of oral and written literature, words are selected as carefully for their sOllnd effects as they are for their meaning.

9. He is well poised. His mental and physical bearing indicates that he believes himself capable of saying what he wants to say. He is Jt ease when h.e tands before a group and he moves about gracefully. His attitude puts his audience at ea e. Because he has confidence in him elf, he secures the confidence of hi audience. IIe is very sure of himself, but not over aggres ive. He speaks directly to the audience.

10. He IS courteous lilld sincere. He treats each member of the audience as if he were his personal guest. He informs, interests and entertains him, and causes him to want to 'listen again'.

11. He is original. He devises ways and means of enabling the listener to give involuntary attentIOn to what he is saying through the use of striking illustratlOns, vivid comparisons, colourful description' and humour incidents.

I ncreasing Self-Confidence

The primary purpose of most courses in public speaking is to increase a person's self-confidence. Because of the increased emphasis placed upon training people, the ability to express himself effectively ha <; become more and more important to the leader. Many effective ideas which might have saved the government unto ld money and man-hours, have 'died on the vine' because the originator lacked the ability to express himself clear ly.

Much can be said about the power of speech, and the effect of well chosen, effectively expressed words upon people.

prep a ration of speech material. Kn ow what you are going to say, a nd how you ar e going to say it.

SKILL: Diligent practice is the only key to skill in public speaking. One must practise at every opportunity and strive to improve with each presentation. In a dditi on, it should be remembered that all speech must accomplish three objectives if it is to be effective. These a re:

CAPTURE INfTIAL ATTENTION: A speaker must devi e a means to capture the initial attention of his listener. Otherwise, his words will fa ll upon deaf ears.

The famous 'Blood, Sweat and Tears' speech by Sir Win ston Churchill was just words, but had a tremendolls effect upon the British people. The late Franklin D. was a ma<;ter of word'i. lie reaI! sed the valuc of clear, Simple language. One of the factors which established his popularity was hIS ability to use simple words effectively. We recall that his famous 'fireside chats' were as easily understood by the 'backwoods' farmer, as they were by the city lawyer. We know from experience that a man on a street corner, who has the ability to speak effectIvely, can sell liS a gadget which we don't really need, or move normal people to lynch or riot. When we glance abou t us, we note that the most Sllccessful people in hoth personal Jnd professlonal life are tho 'e who can stand up on their feet and talk.. Yes, all of these things are accomplished with words. The basic me of the spoken or writ ten word IS to convey our thoughts, ideas and knowledge from one to another. Words are our too\'-. for elfectl\e commu ni cation. Our abtllty to select and properly use these tools l11igh t well determine our success or failure in modern !tfe.

But let's get back to reality and be honest WIth one another. It is I/O! claimed that a course In public peaking will t11Jke a polIshed orator, but it IS claimed that such a course, through practic31 application, will instil a certain amount of se lf-confidence in the individual and place him well on the road to becoming a more effective speaker.

There are three major assets which a person must develop to become a more effectIve speaker.

KNOWLeDGE : Without knowledge, speech would be quite empty. The speaker l11ust possess a broad knowledge of his subject materIal. The more broad the knowledge, the more interesting and effective the speech will be.

SELF-CO F I DENCE: Without self-confidence, a speaker will stumble and lack power. A great deal of sel [-confidence is ga ined by t horougil

words if his speech was effective, the audience shou ld react in the manner planned by the speaker. The ability to speak effectively is an important personal and professional asset. To become a more effective speaker a person must understand the purpose of the spoken word. He must realise that there are certain personal assets which must be developed and that there are certain objectives which all speech must accomplish if it is to be effective.

Platform Behaviour

SWAY AND CO VINCE: A speaker mu st use clear, persuasive language and symbo ls. He should carefully select the mo st meaningful words and phrases, cons tru ct striking examp l es, and create vivid illustrations. A picture is worth a thousand words. A speaker should use pictures, c h art, graphs and other forms of visual illustrations.

MOVE TO ACTIO A speaker should observe some definite desirable reaction on the part of his audience. In other

What is platform behaviour? Simply stated, it is the way a person 'acts' before a group of people. Many times a speaker will spoil a well prepared speech because he possesses a mannerism which is distracting to other people. We will list some of the important factors of platform behaviour and outline some of the accepted methods of safe-guarding against distracting mannerisms.

APPEARANCE: Webster defines appearance as 'coming into view', but for the purposes of a speech course, it might be better defined as 'coming into mind'.

Why? Because a speech presentation actua ll y begins from the very moment a speaker is introduced and before he has uttered a single word. The audience forms a mental impression of him which is based upon his personal appearance. How sh 0 uld a speaker look before an audience? First, his dress should be proper. This is particularly important in uniform where dress is governed by regulations. Second, his posture shou ld be erect, without an appearance of stiffness. Third, his stance should appear natural , but not mechanical. Re member to check your personal appearance as carefully before a speech presentation as you would before a formal uniform inspection.

BODY CONTROL: All bodily activity on the platform should be purposeful. The primary purpose of all bodily gestures is to reinforce an oral expression Gestures used by a speaker should appear natural. Gestures cannot be 'planned'. Such movements will come naturally when the speaker is sincere and enthusiastic about his subject material.

The following bodily behaviour types frequently 'steal' the speaker's verbal message:

LEA ING LEN I , who is always off centre, his weight slumped to one side WOEFUL WALTER, who wrings his hands over some unspoken anguish.

JIGGLING JOE, who constantly teeters back and forth, and up and down.

HOT-FOOT HARRY who appears to be pacing across the top of a hot griddle.

I VE TORY IKE , whose hands continually explore the contents of his pockets.

FIDGETI G FRA K, who heroically

suppres es an urgent ca ll t o the latrine.

JUGGLING JERRY who to ses key, pencils, co ins , chalk and othe r item.

GUILTY G U S , who can' t look you in the eye, a nd can't tell you why.

STO EFACE SAM , the c ig ar- tore Indian who never move.

BUTTO BOB who icon tantly buttoning a nd unbu t toning or twisting them off.

BARRI C ADE BILL , who defies the world f rom behind his fo lded anTIs.

Prob ably no s peaker ever completely avoi d s all of the foregoing traits, b u t when these activities become the most noticeable part of a peech performance, the speaker's me age i lost.

EYE CO TA CT: A good speaker will strive to e tablish a personal relationship with his audience. He wants each member of his audience to feel that he is taking a personal interest on his behalf. To accompli h this, a peaker mu t look at his audience. When a speaker talks to the floor, ceiling, podium or out of the window, his audience is quick to 10 e interest because it is apparent that he has no interest in them. Don' t give your

BOOKS

Food and Your Health Disease and Health Systems of the Human Body

Publish e d in USA and di st ributed b y Guild , Sound and Vi sio n , London. £3.85 a set.

Each book contains twelve colour transparencies for use with an overhead projector teacher s notes and spirit masters for a crossword puzzle, and th r ee review qu iz zes; each book being de si gned as a short course in the subject.

Although not tailored to St. Joh n courses we thought this was a good presentation of a neat and co mp act package.

The transparencies are very good although t o make full u e of them would require an overhead projector , a n item which is not freely available to most classes. How ever by placing them again t a rear illuminated surface, such as a n X-ray viewing box , the picture are clearly visible to a sma ll group and the separate text is c l ear, being just right for 'at a glance' note s.

Th e spirit masters provide excel lent aud ie n ce participation although they contain a n umber of 'Americanisms' which might not be fully understood in other co untrie s. Each would give a considerable number of legibl e copies even without special checks of pressure and s pirit , as might be done by a teacher in a hurry.

The se handbooks cou ld not repla ce the formal St. J ohn courses but t eachers might feel that selected transparencies cou ld be used , a lth ou gh this would preclude a fo ll ow up with quiz or 18

aud ie n ce the 'co ld stare' treatment.

R eme mb er that there are two sides to a r oom, and a front and rear row look at al/ of your audience.

Sometime a member of your audience will convey a me sage to you even though he doe n't speak a oud. When YOLl see a person with a cupped ear in the rear row, he i aying 'Speak louder, I can't hear you '. Wh en you see a per son with a puzzled frown on his face he is saying I didn t understand tha t point'. If a speaker fail to look at hi s audience, imp o r tan me - ages such as these will escape him entirely. Establi h good eye contact with the audience and make each member feel that he has a personal part in the proceedings.

VOICE CONTROL: A good speake r will adjust the volume of his voice to fit the size of his audience. Remember that too much volume is better than too little. Make ure that your message is heard, but raise the pitch of your voice to emphasise important points, and lower it to ease up

Normally a per on speaks at the rate of 140-150 word per minute. Of co ur se there are people who arc capable of crossword.

H owever as an addition to a course or as a 'ref resher' this system could be valuable and would be a useful addition to the armament of an instructor.

Thi s pre entation cou ld also be most valuable in countries with dietary deficiencie as a well trained person cou ld substitute local vegetables, etc, witll ease: and also in this country, especially at schoo level with the increase in immigrant population. The' pirit' may also perform <l dual role In the teaching of English.

There are some differences between the American and English presentations, particularly in the 'quizzes' and crosswords but these are minor and cou ld be overcome by the instructor and we feel they should not be allowed o detract from the overall value.

In general we feel that these handbooks could take their place in the ma ss of educational maleri<ll though the pri ce would determine how high on the list. They are a useful aid t o formal teaching though greater value could be obtained by selecting items from them rather than working thr ough from cover to cover. We feel that their greatest value might be in the use as refre her' material or as a different presentation of subject. with which group was already familiar.

L. K. Cordeaux

Emergency Treatment of Casualties

(Programmed Text)

Local Government Tr ain ing Br anch. £ 1 30

This sma ll wo r k, which slips easi ly into

speaking 190-200 words per minule and remain distinctly underslood.

Such a sk ill requires much training and constant practice. Don t crowd your per. onal capabi litic Suhject material wJlI often dictate ou r rate of speech. Material which reflects action will cause us to speak faster, whereas material wh icll r eflec t s dullnes s and boredom will cause us to speak more s low ly Try recor ding your voice on a tape recorder a nd critically analyse it from the standpoin t of volume, rate, monotone and distinctness.

To SUlllll1arISe, platform hehaviour is the way a person should look. and ad before a group of people. A well prepared speech !l1L1Y be spoiled by d istrad Ing per onal mannen.,llls. All bodily activity on the platforll1 should be purposeful and it should make your audience feel that you mean what you Establish J personal relationshIp with your audIence through proper eye contact and control the voice from the of \ olllme, rate, monotone LInd d istinl'lness.

(COJl tllllll'c1I1Lxt lIIoJ)tiI;

St John Tours

1971 Malta, the Holy Land and Cyprus; 1972 Rhodes, Cyprus, Beirut and Damascus; and now 1973 Rome, Jerusalem , Tiberias and Tel Aviv. These St. John tours of the Old World are becoming a way of life for me, for so far r have had the privilcge of leading all three of them.

Our 1971 party of 27, included people from 10 Distri cts/Counties, two doctors, several SRNs, and Brigade officers and members, several of whom I already knew. We were met at Malta airport by three SJA members, who accompanied us (imparting their invaluable local knowledge) throughout our stay on the island; as also happened later at Cyprus.

As this first tour progressed, our party soon became very united and someone even started calling me 'Father'. This endearment (?) continued throughout the '71 and '72 tours, and was a lso used by guides, agents and hotel staff, one of whom wanted to know why I was not wearing my collar back-to-front! Whereas in Beirut in 1972 our travel agent, having heard me being called 'Father', later

by George Woodhill, tour leader 71, 72 and 73

referred to our passports to discover who was my daughter. But in Cyprus last year the hotel manager and his staff greeted me as 'Doctor'. Later they enquired whether 1 was a doctor of medicine or divinity, to which I replied 'Neither. Just plain Mr.' Bu t I remained Doctor to them throughout our stay at the hotel.

This sense of close-knit unity which has existed in our parties is fostered, I think, by .us sitting together whenever possible at one table for meals. Such meals, in Valletta and Medina in Malta, Paph os, Famagusta and Kyrenia in Cyprus, and in Dam ascus, bring back to me pleasant memories both spiritual and gastronomic.

One of my most spiritual memories of these tours is of Jerusalem in 1971 during Holy Week and Easter, when we attended the dawn service on Easter Sunday in the Garden Tomb. With a congregation of over 1,000, the service was conducted by a Methodist minister, the lesson read by a Dutch minister, the sermon preached by an Anglican clergyman, and the blessing given by the Archbishop of Jerusalem.

the pocket, is suh-titled 'A Short Course in Life-Saving Procedures'. It is <lImed at 'every man, woman and schoo l child'.

In 60 short, ter..,e pages of text It punches home the lessons of breathing, bleeding and unconsciousness. f\lany pages are supp lemented by dIagrams which add appreCIably to the text, except those on pages 84 LInd i->6. which Jre positively mi-,lt'ading.

The book concludes WIth J \ery good summary chart of procedures. [h ere in time, be beller, more sopillstlLated programmt'd texts of f irst Llld. But as a fir't effort thi" is exccllent and descnes to be WIdely ConfIdently recommended.

R. t\lcL Archihald

NUTRITION AND ITS DISORDERS

By Don a ld S. McLar en Churchill Li vi n gs t one. £ 1.50

This is LI nIcely produced 300 page paper back written lor the medical student and as such mecls its aim. It covers in depth normal nul rition, the re"lIlh of under and over nutrition, Ilutritional disorders and nutrition lIsed in lile treatment of vLlrying conditions. I t is a book to be highly recommended t o students of medicine and nursing, but tile depth of its physio logy a nd bio-chemistry puts it beyond the usc of many BrigLlde memher'>, and for this group I thInk it, use would be exceedingly limited. SY

The singing was led by a choir of blind Arab girls from Bethlehem.

The visit to our own St. Jo hn Ophthalmic Hospital in Jerusalem was one of the highlights of the 1971 tour, as it will be in 1973. The warden, matron and staff made us most welcome and proudly showed us over this magnificent hospital which is doing so much for those suffe ring with eye diseases.

When plans were being made for m y first visit to the Holy Land my local minister said to me: Th e Holy Land will mean very little to you unless you do some homework first.' L ater he arrived on my door-step with an armful of books for me to study. On e book was In the Holy Land' by Godfrey C. Robinson and Stephen J. Winward. I have taken this helpful, pocket-size book with me on each visit to the Holy Land ; it's invaluable.

The success of the 1971 tour was indicated by the fact that 12 of that party also came on the 1972 tour. I wonder how many old friends - and newwill we see around the dining-table on the 1973 tour?

ST. JOHN AMBULANCE TOUR SEPT. 1973

Rome: Sept 15th, 16th, 17th including a visit to THE VATICAN

Jerusalem: 18th-26th Pater Noster Church Gethsemane, the Spring of G ihon. Bethlehem, Sh epherds Fi elds, and ST. JOHN OPHTHALMIC HOSPITAL Mt. Calvary, Chu rch of the Holy Sepulchre.

MUR ISTAN, site of the original Chapel of Knights of St. John, Bethany, Tomb of Lazarus, Jericho, Mount of Temptation, The Dead Sea Scrolls in the Book, Wailing Wall, Golden Gate.

-27th. Lake Galilee Caesarea, Ph ilippi and the Gol an Heights Acre ; Crypt of Hospital of Knights of ST. JOHN. Mt. Carmel.

Led by Mr. G Woodhill

NEWS from SCOTLAND

St. John's Hall in Edinburgh

THE WEST BOW i a narrow street connecting the Grassmarket and Lawnmarket in the Royal Mile. It ha considerable fame in the annals of Edinburgh a, a way by which overeign entered the city and a the scene of quaint ceremonials llsed on these occasion Chamber, in an article written in 1822 but republished in his TraditioJ1S of Edinburgh. reported that the original city wall cro sed this street and that there was a gate of which the only remnant by his time W3S one of the hook for the suspension of the hinges, fixed about five feet from the ground on to the front wall of a house. It was from the arch of this gateway that the street took it name, 'bow' being an old word for arch. At the bottom of the West Bow, where it joins the Grassmarket, there were several houses which had crosses on their walls to indicate that they were on 'temple lands': exempt from tithes or tiends and subject to the heritable jurisdiction of the Preceptor of Torphichen and his su ccesso rs.

But at the corner of the upper West Bow and the Lawnmarket stood the St. J ohn's H ail, incorporated into buildings which MacG ibbon and Ross in volume iv of Castellated and Domestic , 1 rchitcclLlre ill Scotland (publi hed 1892), stated it had been removed only 'a few years earlier'. T h ey reported that 'thi hall was latterly used as a wretched dwelling house and all traces of its original purpose W,15 obliterated, but we think there can be no doubt as to its having formerly been a chapel'. They were both architects and gave a plan of the hall, describing and illustrating the five recesses on the west side. It was reached by a flight of steps and at the top of the stairs there was a piscina on the outer wall: a piscina, normally found in medieval churches, wac; a stone basin with a drain emptying on virgin soil in which the utensib used at mass were cleaned and the ritual ablutions performed A wheel stair led to upper floors where rooms with enriched plaster ceilings were situated. The late Dr. Macdonald, in his essay on The Kniglits 0/ Sl. John 0/ Jerusa((!!17 ill Scolland, wrote that the Kings of Scotland went to the I:.dinburgh home of the Preceptor of Torphichen, the Lord St. John, to watch processions passing. When one realises that the position of this house was at the top of Lawnmarket, rather than on the St. J ohn Lands near the Cannongate and out s i cl e the cit y his is qui te understandable.

A view of the Hall of tbe Knights of St. J ohn is to be found in the Abbotsford 20

H a II of the Knights of St. J oh n Ed nburgh

edition of the Waverley Novels (volull1e ix, published 1846) and is reproduced here. It is described as being in the Cannongate, but there were 2,000 illustrations in thiS edition of the \ovels and it is clear that a mistaJ..e has been made for the hall stood some half a mile up the Roy;}1 Mile. The confusion must have arisen because of the number of places associated with Sl. John ncar the Cannongate. St. John's Cross stood in the Cannongate outside the ,>econd , or rlodden. wall of the city whil..h ran roughly along the line of St. \1ar) 's Street. It wa<; here that (,harle" I J..nightl'd the provo::;t when he made his ceremonial entry into J::dinburgh in 1633 rhe street has been widened since thcn a III a circular arrangement of the CluscW,IY indicates the point where the Cr o ss formerly stood , although it IS a pity that the stones are arranged as a St. George' Cross. And nearby i.., 1. John's Pend. St. John's Street, where the chancery of' the Priory now is, dnd Sl. John ' s Iidi.

- J I I.C\Ildcr 1acLeod

Glen shee Ski Re scue Serv c e

The recently founded Perth and Perthshire cOll1millee of the Order now formed an a,>sociation With the: Glenshee Ski Rescuc Sen icc , whll h rescues and give" eIl1ergency treatIl1ent to the injured on the ski slopes hesides tldlnl 'ng young pe:ople in treatment. fhe even newer cOIl1Illitll:e at I:.ast Kilbride has decided to sponsor the building of a hostel at Glenshee to ilouse the trainees in winter and IHO\ Ide accommodation for young peopk in the summer.

WALES

I'he 3rd ,lnnu;!1 CJdet c.lr o l sel"\ll.. c.hcld a the Parish Cl1url' h of Sl. John Cardlll, nn December l) and attended hy nwre than ollieers and cadL'ls, \\a" c o ndul ted hy Canon \\' 1 C [,hom:.!s , ,In olCil iJting chapl,"n to the Prior) fo r "'aks Less o ns \\ere read b) l udeh representing the \dri o us Distnl..!s ;Ind Counties, the former ChicI' Cadet OITil'er \1r s. J. D. Il1lth. the Chid urgl o n for Wales. ])r. I. R S Rohert s on. \.Iso IHc<.;enl were the Chle! COlllmlssloner for \Vales Lt Col. J R L. Trahe:rne. the eh Id Su perIlltenden t ror Wale,> , Lady Crawsh,IY. the Secrcl.lry 1'01' \\ ales \1 r. C. J Parr}, and the Direltor 0 1 \1 r. J P Pickford.

At the heglnl1ing of Nmcmbel ,II our South Wales I raining Course Il1l'mber'> to o !.. pdrt In dn e'(erl' ise whidl transformed thc Pleasu r e Ground of Coney Porthcawl. Il1tO a di saster

alea As d result 01 dn eaIlh treillor SOIIlt' 50 casualt les were trapped and inJIllTt.l. Briga de mell1 be rs fro III a II pa rts 01 Sou t II Wales attending the conference wcre called upon to render help and as s istance

The men formed themselves into teams and tile nursing persollnel ,>et LIp :I reception centre at the fairground bar.

The exerci<;e was under the dirL'ction

of the Chief Surgeon for Wales, Dr. I. R. S. Robertson, and a panel of 12 medical practitioners aSSisted as Judges, among them the Deputy Surgeon-In-Chief, Dr. R. "1. Archlb,Ild, and Major H Kemp, who attended the conference as guests of the Priory lor \\ tle s.

The Conference was opened hy the Chief C0Il1111ISSIOner for Wales, Lt. C o l. 1 R. L. rrailerne

On the Sat mda) evening the c o urse were the guests o f Porthcawl L DC to a civic reL'e:pli o n and dan c e

On the ,dter service conduL'led h} Rev. Gcraint bans. a serving officer In the Bng Llde, the Deputy Chie[ Surgeon for \\ alc::; Dr. L. T LewI'> , and lleLlciq uarter Staff Officer, Dr D. Chambers, gave their Impressions on the 3rcl Edition of the First Aid \Ianual, which \\ as fo ll o wed by a forum o f surgeons ans\'vering questions. fhe Chief uperllltendent for Wales , Lad) Cr lw'ihll), mel nur,ing peronnel at a special session to disL'll!)s lllutual problems.

The conference ended with the showing o f the Lord Prior's film ThiS Sgt Hywel Harrres of Brldgend DIVISion, became a radio enthusiast, now thp. DiVision has its own radiO system

Dr Menai Prrce, DiviSional Surgeon, Mid Glamorgan District, examines a casual ty at the recepti on centre

S Wales Training Course

A casualty being res cued from the debris con Ference wa well attended and enjoyed by everybody.

Bndgend D vision is fortunate in havlJlg a group of keen a nd active young Brigade :'1embers. Two of them , \'v ho had undertaJ..en radio communication cour e , were keen for the Division to po ess it own radio equipment, so under the guidance of the Superintendent and with the help of Corporal Michael Ore,

Sgt. Hywel Harries, a Grand Prior Cadet. organised concert. nffles. jumble sales and eventually raised The Division ha now purchaed enough radio equipment to enable them to have radio contact while undertaking public dutle on beaches and at sporting event. Sgt. Hywel Harries, by the way, is the leader of the local ca ualty imulation group. J team who regularly assist at all local and national competition He ha passed a selection board for officers, and attended K.G. VI Leadership courses.

At Montgomeryshire's Brigade annual dinner and dance: (I to r) The Lord Lieutenant, Col Corbett -Winder; Mrs. Margaret Davies, Lady President; Mr D. W Rees, CountY Staff Officer, retiring after 15 years service; Mr. C V Davies, County Commissioner; and Mrs. D W Rees

News from the Divisions

LANCS 65 pcople attcnded a get-together to celebrate the Warrington HQ Division's 75th anniversary on De cember IS, when Area Supt. R. Banks made a presentation to Div. Supt. G. Ligh tfoot on his retirement from the division after 32 years' service. The Clough Bowl was presented to Cpl. E. Lunt.

YORKS - A very successful dinner of the Bradford Corps was held on January 12, attended by the corp staff and some sixty officers and members from the various city divisions.

The Corps President, Mr. C. evllJe Packett welcomed as official guests Major R. Ingham (Chairman, West Ridll1g Council of the Order) and Mrs. Ingham (President, West Riding District of St. John Ambulance); Dr. W. E. Alderson (the former Corps Pre ident) and Mrs. Alderson.

During the evening the films 'Journey to Jerusalem' 'The Order of St. John', and the 'Lord Prior's Film' were hawn, and a presentation of gift vouchers was made to Mrs. A . Lorimer, lately Corp Superintendent (Nurstng), as a token of appreciation for her rna valuable service to the Corp, and with congratulations on her recent promotion to the Area Staff.

Co Durham's Wolviston and District Cadet Superintendent Mrs J Berryman. who joined as a cadet, later to form this Cadet Division, receives her 15 year Service Award from County Commissioner Dr. A Burns

This was the first dinner of the Bradford Corp,;, and it is hoped it may hecoille all annllal event.

OBITUARY

Alfred C. Eatwell, Divisional Officer and Treaslirer, Ilungerford , Berks, A & Divi s ion Serving Brother. Member of the Brigade since 1933.

William R. Mitchell, Divi siona l Superintendent, Navocastriill1 Ambulance Division, Northumberland.

Leslie H arris, recently retired London District Secretary. Commander of the Order Joined Brigdde 1I1 1927.

Two West SuffOlk Cadet Divisions, West

and

Bury

Three times as many

Teesside's

REVI EW CROSSWORD No.3 ( 73) Compiled by W. A. Potter

ACROSS

1. Early sign of deficient circulation in a limb. (8). 5. Worker with spirit in bony cavity. (6). 9. Ripe cargo provides old-fashioned, opium -containing sedative. (9). 11. One way to carry a rifle along a track. (5). 12. Just a little of an ophthalmic preparation. (3-4).

13. Act in improper sale for 21 Down (7). 14. Putr efaction occurring in middle of artery of neck. (7). 15. Ob cures features in grave illness. (4). 19. Very unusual way to prepare a steak. (4).

20. Gait of person liable to fall after too many dr a ms of spirit? (7).

24. Related to the diaphragm and the mind. (7). 25. Natural discharges of waste products from chalk. (7). 26. From two directions attempt a passage. (5). 27. Prepare instruments for surgery. (9) 28. Doctor ingests chopped suet used by cleaner. (6). 29 . From Eastern port it is inflammation of lymph at ic gland. (8).

DOWN :

1. Completed like the knee-joint? (6). 2. Real confusion about dud cheque for food store. (6). 3. We s t African spilt gin in ear. (8). 4. Organism causing scarlet fever, erysipelas, and many forms of septicaemia. (13). 6 Information about forthcoming event where, it appears, there ca n be no skati ng. (6). 7. Fi ssures in the skin coming from a hard seg. (8). 8. Bony prominences at the ankles (8). 10. Upper respirato ry tract infe ctio n prevented by wearing a warm cap? (4.2.3.4). 16. Continuous, slow supply of nourishment by gastric tube. (4.4) 17 Sev ere itching. (8). 18. Applied to reduce and maintain position of fractured femur. (8). 21. Secretion bringing about digestion of food. (6). 22. Parti a l saint employed to clear condensation. (6). 23. An act of endearment scares badly. (6).

SOLUTION TO CROSS WORD No 2 (73 )

ACROSS

1. Red spot; 5 Iodised; 9. Mosquito forceps; 11. Toe; 12 Dur a; 13. Trout; 14. Blue; 17. Spittoon ; 19. Tap is; 22. Aryan; 23. Smallpox; 25. A bet ; 28. Senna; 30. Lame ; 31. Rap 34. Argyll Robertson ; 35. Tetanic; 36. Bladder.

DOWN :

1. Remedy; 2. Dys trophy; 3 Pout; 4. Tut or; 5. Influenza; 6. Dirt; 7. St.eel; 8. Dispense; 10. Cob; 15. Sting ; 16 Stall ; 18. Obstetric; 20. Prolapsed; 21. Cataract; 24. Le .a ner 26. Er.got; 27. Tay; 29. N.a.bob; 32. Plan ; 33. Urea.

24

FILMS

The St John Ambulance Film Appr aisal Panel, which meets fortnightly at Headquarters consists of do cto rs first aiders an d visual aid experts who offer their services for this important aspect of visual aids.

Prev iews of those 16mm films recomm ended by the panel are regularly published in the St. John R eview.

RESPIRATION

IN MAN ( 1972) (Co our 25 m ins) H ire

National Audio Visual Aids Library - Distributors - Paxton Pl ace, Gipsy Road, London SE27. P roduced by : Encyclopaedia Britannia

Th e respiratory y tern in man is tudied and explained. Illu strative laboratory expe riment how how the exchange of oxygen and carbon dioxide is effecte d.

The panel considered this a very interesting film with notable laryngosopi c photography and excellent use of X-ray diagrams t o portray lung expansion. Producti on value are first rate and the whole film very professional. How ever, for first aid classe this film is pitched at a level that cause t h e need of the services of a doctor or lay in tructor to an wer que tion after screeni ng

Audience: Mainly medical a nd nur ing students but could be screened to experienced first aider and is also suitable for courses upon hy giene.

A NE V'J TR A IN I NG FILM

Many Countie, Divisions and Centres will be aware of the excellent training film 'Don't Let H im Die'. Ind eed it has been in use for 5/6 years.

Messrs Stewart H ardy Films, who produced 'Don't Let Him Die' for the Ministry of D efence ( avy), has now produced a sequel entitled 'Give H im Air'. The St. John Ambulance Appraisal Panel said of this production:

'This first-aid film is made for an audience with little or no first-aid knowledge an d demonstrate the need to ensure that casualties not only 'get air now' but continue to do so until trained h e lp arrives. It pre ents by mean of accident ituation and animation the importance of c learance of the airway, the recov ery position, mouth-to-mouth resuscitation, etc; it i a very well-produced film of ideal length and precise, wellbal anced content; it is especially remarkable in portraying 'Stove-in Chest' and 'Stabbing wound of the Chest' incident

Minor criticism may b e offered in respect of casua lt y si mulati on at times less than perfect and the method of placing cas ua lties in the recovery position, which cou ld be more ab ly demonstrat ed than in the film

This film shou ld be viewed by all first aiders and de erve universal exhibition.'

The producers of the film, which is colou r , l6mm and runs for 20 minutes, have granted members of St. John Ambulan ce the privilege of buying prints at £35 each, (Ilalf the usual price), frol11

Vi s ual Aid Se ctio n St. J o hn Ambulance HQ 1 Grosvenor Crescent, Lond on SW I

MICRO -ORGANISMS : HARMFUL ACTIVITI ES

( Co l. 16 m n s) Hire £2.75

Distributed by Indiana/Gateway, 470 Green Lanes, London N.13.

Uses microscope , live photography a nd animation to how how micro-organisms ca us e di sease and undesirable de s truction De als with co ntrol of harmful micro-organisms undesi ra ble activities and disease.

The panel considered this a well-produced film from th e technical view-point but somewhat hazy in its objective. It showS resear ch into Ba c teria but is too general in some parts and too technical in others, it lacks clarity.

Audience: Nursing students and bacteriological students. Ha s some valLie in hygienic food handling courses.

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MOORFIELDS EYE HOSPITAL CITY ROAD, LONDON , E.C.l.

Vacancies eXist for State Enrolled Nurses to enter for the Post Enrolled training in OphthalmiC Nurslflg Twelve months' course, of w hich two months are spent In the Schoo of NurSing. Moorfields Certificate of Pr ofiCiency and Medal awar ded to successful candidates who are also prepared for th e Pr of iC ency Certificates o the Ophtha lmi c NurSing Board. Opportunities for promotion and practical responsibility In the specialist field of nursing.

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Candidal es accepted at the age of 17 to commence an 18 month course of t ra ning ()s OphthalmiC Students, Moorfle lds Medal and Certificate awarded to successful can didates , Well equipped School of Nursing, Successfu candidates, on co mpl e tion may enter the General Training School of their choice. Comfortable

Anatomical Teaching Models

ST JOHN HOUSE CLUB

REVIEW

50

ST. JOHN REVIEW

Order now - £1.70p. for a year's subscription i nclud i ng pos t a ge, and don't forget bulk orders of 6 or more copies a month (minimum 3 months ) at a special rate of 10p. a copy including postage

Hearing Loss in the Elderly by Dennis Clark, MSE, F RCS p.4

Around and About by the Editor p 6

Training o u r Leaders, part 2 p 10

As Others See Us p 13

Readers Views p.14

Better to die living - than to live dying by Mrs Wendy Mitchell SRN, SCN p 16

Order I nvestiture, Feb 22 p 18

Films p.1 9

News from Scotland p.20

Overseas p .21

News from the DiviSions p.22

National First Aid Competition p 24 ED ITOR' FRANK DRISCOLL 26 Pembroke Gardens London, W8 6HU (01 6038512)

AD V ERTI SEMENTS : DenniS W Mayes Ltd. 69 Fleet St ., London , EC4 (01 3534447 and 4412)

Prrce 12p £1 70 per annum, Including postage, from Review Sales, St John Ambulance 1 Grosvenor Crescent , London SWl X 7E F

Review Sales, St. John Ambulance, 1 Grosvenor Crescent London SW1X 7EF

The St Ives new combined F rst Aid and Res c ue Service (see Around and About December 1972 ), organised bySJA and the Coast Guard, at a rescue bid on the cliffs dUring January One life was saved, two were lost (Photo S Bennetts St Ives)

AT RANDOM

by VlJatkin W, Williams Deputy Commissioner -in -Chief

I\, A RECE\lT report on resuscitation after electric hock , discll sed in a Lallcet editorial and later referred to in the national pre s, Dr R. !\forley and A. O . Carter que tioned the value of oral re uscitation combined with cardiac rna sage in ca es of electrical accident. Their ground for doing 0 are reported to have been: (a) that cardiac massage interfere with artificial re piration: (b) that, of 80 people who died after electrical accident. 56 (i.e. 70 o/c ) had evidence of heart failure which \Va relatively rare in non-fatal ca e : (C) that in dealing \\lith respiratory failure due to electric shock, method involving compression of the chest with pa sive movements of the arms eemed to give better re ult than oral resuscitation. They al 0 referred to the 'my terious recovery' of all of even electrical casualties after quite untrained people had 'moved the victim' arm and leg': and they recommended that for re u citation after electric shock the on or chafer method hould be preferred to mouth-to-mouth. and that cardiac fir t aid hould be restricted to 'one or two harp blow to the chest'. :'\ot many lay member of the Association or the Brigade are in the habit of reading the Lancet: but when subject discu ' sed in that profe ional journal find their way into the daily paper they readily catch the layman's eye and, if they have a bearing on fir t aid, may cause him some anxiety about the oundne of hi training. So it i not surpri ing that very oon after the JppearLl11Ce of the e pres comment 1 heard of anxious enquiries from St. John member about whether in thi pJrticular respect the latest edition of the Joint 1anual \Va out of date almo t before the ink wa dry. However. the Chief ;'ledical Officer of the ociation and the urgeon-in-Chief of the Brigade were - a one would expe 'on the ball'. and for the reassurance of any t. J olm member who may have been disturbed over this matter 1 have their permi ion to quote a letter which they wrote jointly to the Lance! and which JPpeared in it i ue of February 17:

'The re c ommendations of Morley and Carter referred to in your editorial of 3 February are naturally of great interest to us, especially the reported high primary cardiac death rate and the rec o mmendation for two 'thump '. With this the Joint Manual almo t entirel) agree. except that we are prepared to go up to ten. The ugge tion that Holger-:\,iel on or Schafer, by virtue of mo\'emen t of the limb ,ha a beneficial cardiac as well as respiratory effect i mo t intere ting. We think this may well be due to Il1creased \'enou pressure acting a a timulus in much the ame manner that rai ing the leg may restart an arrested heart. The Manual doe in fact include Holger-0iielson (better than ch:Jfer), although not for the reasons uggested by forley and Continued all page 9

Compression Syndrome in the Leg

FIRST -AlDERS

by R. A. Elso n, MB , FRCS

THE WORD syndrome is applied to a group of symptoms or signs which can occur together and which stem from a common cause. For example, a heart attack due to sudden interference of the bloo d 'supply to the hea r t muscle, may r esult in pain in the chest, spread of the pain into the neck or arms, breathlessn ess, palpitation, fear, faintness - all of these comprise a syndrome and enable the doctor to make a correct diagnosis. Sometimes only one or more of the symptoms may be present and the diagnosis more difficult to make. Thus every cause of a disease and its associated signs and symptoms could be described as a syndrome, but more commonly doctors apply the term to special examples where the pattern of the symptoms is a little unusual or even surprising Sometimes , a syndrome is named after the person who first recognised it

An example of a syndrome about which first-aiders should know is the Calf Compression Syndrome in the leg. A variant of this is the Anterior Tibial Syndrome, and both of these will be described.

The leg (in anatomy, leg refers to that part of the lower limb between the knee and the ankle) consists of the tibia and fibula clothed by muscles whose actions relate almost entirely to the foot and toes. Important arteries and nerves pass between the muscles and supply the foot - on their way they supply smaller branches to the muscles of the calf and part of the leg. What is less frequently described is that these muscles are en2

closed in a tough membranous envelope called deep fascia. Although it is supple, this forms a rather inelastic sheath. Further, the investing outer layer, which spreads right round the circumference of the leg, is connected by several equally

strong septa which break down the leg into a series of compartment. Each compartment contains a mu cle or group of muscles and has its own blood and nerve supply.

Thus, the muscles and their supplying

vessels have to function in a container whose walls, while fairly flexible , do not stretch very much. If anything happened to make the muscle swell, a rise in the pressure of the compartment would be inevitable.

In fact, the volume of the mus c le can change. During activity, for example, it s blood supply increases, but this higher arterial inflow is balanced by the more rapid venou outflow every time the musc le contracts, it sq ueezes its own veins and drives out the blood in them ; when it relaxes, the veins fill with blood which has been driven through the capillaries. The muscles act as a pump and provide an important mechanism whereby blood is returned to the heart the muscle s pump the blood back up the large veins of the leg

Normally, any increase in volume of the muscle can be compe n sated by squeezing out of some blood through the veins , but there are some <lbnormal situations in which the volume increase of the muscle can exceed the amount of blood which c<.ln be ejected from the compartment a nd, if thi s happens, the pressure In the compartment will rise. The first effect of tl1lS will be for the vein to be squa hed from outside. Now we have a very dangerou situ<ltion: blood wanting to leave the capillaries of the mu cle finds that Its progress IS halted by the comp ressed veins; therefore. the capillary blood becomes dammed and the volume of the muscle increases el'en //lore; the veins are further compressed. The result IS a vlcioll circle. for the arterial blood which IS at high pressure is still able to be driven into the capi llaries. The pressure in the compartment continues to ri'ie a nd there comes a time when it begll1s to exceed the artenal pressure At this point, the <lrtenes upplYlng blood to the muscle become squa hed <lnd the muscle loses its blood supply. Whenever muscle i depnved of its blood supply, it be comes very painful and tender thi s is the basi. of the pain of a heart att<.lCK or perhaps of mmcle cramp when <.I muscle goes into spasm contraction) and in this hard, t e nse state, arterial blood IS unable to get in. In the calf syndrome, when the advanced. tate described above has been reached, tile los of blood supply is complete, and the consequent p<lin and tenderness is severe. This is the main feature of the syndrome: severe pain and tenderness of the affected muscle out of all proportion to what should be expected

Thus, if there has been an injury in which the tibia has been fr<lctured perhaps onlv a crack and the limb been prope;ly splinted, the p<lin should be bearable or controlled by relatively mild drugs. A plaster cast may have been applied. Should the calf syndromc develop, the pain will be out of <III proportion to what should be e xpected Pain, however severe, can alway be con-

trolled and if the nurses and doctors are not aware of the occasional possibility of the calf syndrome, more and more sedation can be offered so that the pain is eventually conquered, but the muscle remains deprived of its blood supply it must die and thereafter it will never function agall1. The undue pain, made worse on attempting to contract the muscle (movements of the toes or ankle would aggravate the discomfort severely) and perhaps some numbness of the foot or toes (because the nerves also are deprived of their blood supply as they pass down the affected compressed co mpartment) are the hallmarks of the syndrome.

There are two traps for the unwary: firstly, the blood supply to the foot will appear normal because the large arteries which course throughout the length of the compressed co mpartments are carrying blood at a very high pressure, sufficient to overcome the compartment raised pressure. It is branches of the main artery, the smaller arteries supplying the muscles , which are compressed. These contai,l blood at a lower pressure ann ue much more ea ily sq uashed by the surrounding swollen compartment Se co ndly, the injury may be mild. On refle c tion, thi not surprising, for any frac ture can tear the deep fascia where the lat te r is attached to the bone ; if the faSCIa is torn, it acts like a safety valve, allowing muscle to swe ll and bulge out through the tear without raising the pressure inside the compartment The dangerous sort of injury is the severe blow on the calf which may be sufficient to crack the tibia but not displace the

St John Stories

fracture or tear the deep fascia. The contused muscle swells and sets off the vicious circle described above.

There is a curious, uncommon condition affecting walkers and runners, especially if untrained, which is related to the Calf Compression Syndrome. It affects the front compartment containing the muscles which dorsiflex the toes and foot, i J!. particular the tibialis anterior. After or during severe exercise, the athlete or soldier complains of pain in the shins. Usually, it settles with rest, but sometimes the swollen muscle compresses the veins and arteries so much that the arterial supply is irreparably impaired and the affected muscle will become permanently weak.

Advice for F i rs t -Aider s

1. Always encourage the venous drainage of an injured leg by elevating the part after efficient splintage.

2. If you are caring for a patient whose injured leg has been splinted properly, but despite this there is increasing pain and tendernes of the calf muscles, seek medical aid at once. If the calf syndrome is diagnosed, it may be necessary to decompress the part by slitting the whole length of the fascia, so decompre sing the area - if the operation is going to succeed, it must be performed early and the sooner the surgeon knows and recognises the condition, the better the chances of success.

3. Any athlete who develops signs of the Anterior Tibial Syndrome (the splints, it is sometimes called) must stop the event and elevate his legs.

ST. JOH\i Ai\1BULANCE exi ts to help people people of all classes creed and colour, in the largest cities to the smallest hamlet, in work and in play. We are concerned, in other words , with humanity in its broadest sense. As are the world' best story tellers. Our idea, then is to try to record the be t S1. John tories which will illu trate the va field of our orgal1l ation' work with people. They will be tragic torie, funny stories, stories that throw light on human nature, stories about people involved with people.

Send them in to St. John Storie, I Gro venor Crescent, London SWI X 7EF preferably typed, treble spacing, on one sid e of the pa per only, wi th your name and addre s. We will make a monthly selection of stories submitted publishing the best in the Review and giving three prizes of £3, £2 and £ 1 for the be t three every month.

Our members mu t have experienced m<lny sllch incident which would make good reading for Cctdet and Juniors for all members , In facL Our idea is to collect as many St. John stories as pos ible and then publish the best in book form. The stories may be of any length, but, remember, a good story is llsually a short story - 500 to 1500 words; while a very hort story can be as short as 100 words. We are also looking for very short howlers - the funny reply to a first aid question, etc.

3

Hearing Loss in the Elderly

AND HOW TO HELP PEOPLE WHO

HAVE DIFFICULTIES WITH THEIR AIDS

BY DENNIS CLARK , MBE, FRCS.

WITH THE DISTRIBUTIO of free hearing aids by the National Health Service, a need has developed for a simple guide to handling these aids. Such a guide must include a simple explanation of the conditions for which they are given, particularly those conditions, as in old age, where personal service to the patient is necessary.

Hearing is started when sound waves enter the ear on each side and vibrate the ear drum It is continued by vibrations travelling through the bones on the middle ear and thence to the inner ear. In the inner ear sound waves are changed into nerve impu ses and carried along the hearing nerve to the brain The impulses in that nerve are distributed to both sides of the brain so that a complicated co-ordination occurs and understanding of sound takes the place of dis cernme nt of sound.

De afness is the interruption of either soun d vibr ation or nerve impulse at any part of this hearing path. If sound vibrations are stopped in the ear passage by swelling or wax (for example), or if they a re damped down in the middle ear by such co nditi ons as inflammation or scars, the resultant deafness is known as a 'conductive' deafness. In these conditions hearing is improved by louder sounds and, in fact, sufferers from this kind of deafness often hear bett er in noisy s urrounding s. The deafness resulting from interruption of the nerve impulses is quite different a nd is known as 'sensori-neural deafnes s. it is caused by injury or disease in the inner ear or in the hearing nerve. In this deafness the typical loss is one of high tones, the sounds often at the 4

beginning and the end of words (some of the consonant sounds), and this results in a loss of clarity. Such sufferer may even be intulerant of loud noises and need clear, carefully enunciated speech.

As hearing nerve impulses are quickly taken to both sides of the brain, deafne s must result from brain damage on both sides. Severe deterioration due to age, true senility, can do this and cau e the so-called 'central' deafne s in which there is marked slowness in appreciating the meaning of speech. It is quite important to re cognise this group beca use hearing aids in these patients are almost useless and may, in fact, be harmful. Other helpful signs of true senility include a loss of memory for recent events (particularly recent conversation), living in the past ,

persistent ideas in spite of a change of subject, emotional irritability and instability, actions by habit (including their manners) and finally easy tartling by sudden noises. Almost all these signs are aggravated by deafness.

In old age all three type of deafnes can occur separately or, more commonly, together. Senile patients with central deafnes need specia l care and attention. They need to hear speech mainly for guidance in feeding, hygiene and other essentia ls of life. They often require a speaker clo e uP. peaking di tinctly into the ear, becau e as a rule they cannot read the face or lip. If you are called to help these people, speak slowly, emphasise consonants, separate each word and, above all, do not shout.

Rem ember they cannot tolerate loud noises.

Apart from the seni l e there arc a large number of patients, often much o lder in years but younger in vitality, who help them se lves to hear remarkably well. They look the peaker in the eye, reading the speec h from facial expression, lip movements and ge tures , with a facility they are the first to deny. They use their experience of language and the habitual use of phrases and often outrun the speaker by guessing what is coming next before it is spoken.

These people appreciate a clear view of the speaker, a good light, speech directed at them and clear careful enunciation, These are the people who may have suffered from damage to their hearing earlier in life cau ed by such conditions as in inflammations, blast ITIJunes and industrial noise. They have for years com pen ated quite uncon ciously for their hearing los. The e are the elderly group who will find some, though limited, assistance from a hearing aid.

Cupping the hand to the ear to make a mechanical collector of sound is the simplest form of aid. This principle of ound collection ha been developed over the years into a large variety of ear trumpets speaking tubes and auricle. All these have the great advantage of being under the contro l of the listener and not the speaker. They are therefore particularly useful for the enile patient who can be over-tired by a persistent speaker. In general, however, electrical aids have superst'!ded mechanical devices.

An electrical aid in es ence built up of a microphone to convert ounds into electrical impul es, an amplifier to increase the electrical impul e and a receiver to change the amplified impulse back into sound. The amplified ound i conducted into the ear by an ear mould. There are so many types of e le ctrical hearing aid that con ideration can on ly be given to the Medre co Transi tor Aid, issued free through the H S., in which the microphone and amplifier are housed in a plastic case worn on the body and connected to the receiver by a wire lead.

Until ear-level aid are ued where all the parts of the aid are worn the ear, special attention must be given to the ear mould, receiver wire lead, the 'on and off' with 'volume control' switch the batteries and the position of' the microphone.

The ear mould must fit comfortab ly yet very c lose ly to prevent 'squealing'. 'Squealing' is a s'reech caused by sound from the receiver being Picked up by the microphone and ?mp lifi ed again and again : technically it IS known as oscillation. It can be prevented by isolating the receiver from the microphone thr ough a close fit in the ear or by turning down the volume co ntrol switch. The ear mould fitted to the receiver by a clip which, if loose, may

a llow oscillation to develop. A pla stic washer, usually provided with the aid seals this leakage of sound. unclipped, the ear mould must be washed in soap and water and the sound hole in it cleansed of wax or dirt with wire bristle or pipe cleaner. It is the only part of the aid that may be washed.

The receiver wire lead is fragile. Three lengths are now available but in spite of thi when worn by elderly people they dangle into food or are caught in the hands . The ead is best worn behind the neck and over the opposite shoulder from the ear in which the receiver is fitted. Like the amplifier, it can then be hidden by clothing.

The amplifier in its case is best worn in the front of the breast bone, by men under a tie , by women on underclothing or hung round the neck in a small bag,. Within the same case are housed the battery and the microphone. The microphone must face away from the wearer's bo ly and be high enough not only to collect speech directed towards the face but also to monitor the wearer's own speech. Amplification is controlled by turning an on and off' switch (combined with volume control) in the form of a wheel at the top corner of the plastic case. This wheel has proved difficult to the elderly rheumatic finger, and if soiled with food become almost impossible to turn.

Apart [rom these difficulties , the elderly often find it extremely difficult to acquire new habits. For many years the elderly deaf have po sibly lived in a quiet, relatively peaceful world of their own. Often they rightly do not wi h to be

A RECORD?

disturbed and have to be enticed into enjoying sounds. R epeatedly they may require the ear mould to be put into their ear; the tube into the ear hole, the upper hook into the deep hollow above the ear hole and the body of the mould clipped gently into the cup of the ear, possibly eased into place by pulling the ear backwards. Gradually, with patience, even hands severely affected by rheumatic can be trained to insert the ear mould correctly. If the attendant is careful to encourage an elderly patient to wear a hearing aid for frequent short intervals each day; to keep it turned low at first; to avoid sudden loud noises and to take an aid away on seeing a tired, strained look appear or on noticing failure of hearing after a few minutes, then that attendant will be able to train an elderly person into an enjoyment that can only do good.

For the elderly person, hearing aids have definite limitations. They will never replace normal hearing; at best they can add to sound signa s tha t make conversation more clearly appreciated and at the worst they so add to the distortion of sounds that speech is unintelligible. They cannot pick out wanted sounds from background noise and confusion is often increased because of this. They will not pick up distant speech easily. Therefore remember: always speak correctly in the manner already described: always assume that the listener is using his eyes to help hearing; assist with hearing aids both in training and tracking down faults and get to know where in your locality expert assistance can be obtained when needed.

THE PARTS OF A HEARING AID

WELCOME

Miss Lucinda Romilly, the new Assistant Superintendent-in-Chief, was appointed County Superintendent (N) Kent in 1971 Assistant County Superintendent ( ) Kent in 1959 and County Superintendent (N) Herefordshire in 1952, and has been actively engaged with

the St. J olm Red Cross Hospital Libraries Department since 1950. In 1937 she joined the Women's Transport Service , in which she served throughout the war. She was a driving instructor at Camberley Training Centre when the Queen as Princess Elizabeth, attended a driving course.

Just prior to her Headquarters' appointment she was involved in the preparation and manning of the Asian Reception Centre at West Malling, Kent.

RETIRING

Major T. E. spencer MBE, TD, County Secretary of Lancashire and the Duke of Lancaster's District , retires on April ] 1.

Major Spencer joined St. John in Jan uary 1928 as District Clerk to H on.

Sec. W. J. F. Washington, at headq uarters in Fishergate, Preston, when the Distri ct comprised Cheshire, Cumberland, Westmoreland, Lancashire and the Isle of Man. After war service from 1939 to '45 (he was a prisoner-of-war in Malaya '41 to '45) Major Spencer became District Secretary in 1946. With the setting up of the St. John Council for Lancashire, the move from Fishergate to the present premises in Mount Street and the revival of the Association Branch in Lancashire - all in 1949 - Major Spencer was appointed both Association and Brigade Secretary.

We WIsh him all the best in retiremen t.

The new Secretary is Charles E. Neath, Assistant Secretary at Preston since 1970.

AROUND and ABOUT

AT'S GOING ON IN THE WORLD OF ST. JOHN

BY TH E E DITOR

SI GNS

Hebden Bridge SJ A Association and Brigade , Halifax, Yorkshire, received more upport last year than it had had for many years, the secretary, Mr Frank Mitchell, said at the annual meeting recently Mr. Mitchell , who wa presenting the 85th annual report , said the increased support followed a few years of decline in the interests of the organisation.

During the year members had attended weekly classes and fulfilled public duties, sometimes on two or three occasions each week. There had been a slight increa e in nursing division membership, with the transfer of senior cadets.

Mr. Mitchell said that during the year the Ambulance Cadet Divis ion had been reformed, with eight uniformed cadets, and a further number under instruction . This was chiefly due to the efforts of Mr. K. J. Sunderland, who had taken charge of the boys, and was working in co-operation with the divisional

APPOINTMENTS

Headquarters: Mr. J. ew co mbe to Chief Training Officer, HQ Training Centre.

Derbyshire : Mr. Walter Stansfield appointed Chairman St. John Council. There is at present no Council but Mr. St<lnsfield will now be forming one. Mr. Colin Hawe appointed omm. High Peak Area.

Major D. A. Meadows appointed Comm., Derwent Area.

Devon : Rear Admiral W A Haynes, CB, OBE to Comm S Devon Area. Vice Lt-Col. C. M

Townsend. Mrs. L. 1. Townsend resigns as County Supt. ( ). Surrey: Mr. D. E. Henderson to Comm. We st Area Vice My. J. M Ball resigned

Warwick : Mr. E. O. Crosby to Dep. Commissioner. Mr. T. A Atherton to omm Coventry Area. Major J C. Nixon to Comm. North Area.

superintendent of nursing cadets, Miss S. Akroyd , in the founding of two strong cadet divisions. The work included not only first aid and nursing, but swimming and other subjects.

He said that the mobile first aid unit caravan, presented during the year by Hebden Bridge Rotary Club and Inner Wheel , had been a great asset at outdoor functions, which appeared to be on the increa e.

'More events are being held and our services are being called upon more and more', he said. PL EIt S l Aee f t1 rfl /s e/r[ J W/f/f J110 BE /{ E

The above cryptic note arrived in a small package addre, ed to St. John Ambulance at the office of the Order the other day. The package contained 39 books of ational Saving Certificate, total value £292.50p.

I.'m sorry I just cou ldn't keep it quiet - sir or madam but thank from SJ A.

KI NG ' S FUND BOOKS

The Chie f Nur sing Offi ce r w o ul d lik e m e mbers to be a wa re o f th e fo ll owing publi c a ions whi ch ar e a vail abl e f r o m the K i ng Edward Ho sp ita l Fund fo r Lon do n , 14 Pal ace C ourt , Lond o n , W2 4HT :

Ca t al o gu e of Ga rments for the Hand icapp e d and D isable d T wo loose-leaf illu strated vo lum es listi n g clothes and footwear tested by h os pit al trial s a nd by the Shirley In s titu t e a nd Disa bled Livi n g Found a ti o n Tw o volumes £5 50.

British Health Centres D ir ec t o ry - £ 2. 00

Sc hoo l of N urs ing D irecto ry - First c omprehensive d ir e ctory o f sc h oo ls of nursing n the U nit e d K ingd

0 D ire cto ry of Con vale s cen t Ho mes

Det a ils of National Health Se rvic e a nd ind e p e nden ho me s acc epting

o matter what the situation

Calm and reassure the patient. Stop the b leeding, stort the breath; Forgetting these cou ld lead to death.

So many things that I don't know

R ing J oe, at Offton 530

For shock (up 'e t to nervous system)

Give patient warmth, fre hair, ond rest him.

I mmobilise the fractured joint, Elevate the bleeding point, Sterile dressing on injured ite, Otherwise, infect you might.

During the course the pupil learns How to deal with scalds and burn, Don't worry, panic or get tense , Simply use your common sen e.

I think I'm in a state of shock, I'll have to call and see my doc Or else have warmth, fre h air and re To help me through this bleeding te t.

COLONELJ.M.WEST,CBE,TD

work of st. Joh n not only in Shropshi r e but in the country as a whole and we were

The following obituary was received from Shropshire: indeed fortunate to have his continued support and friendly guidance after he ceased to be Commissioner. Colonel] ames West died suddenly at his home in Shropshire on February 6 1973. Everyone connected with the work of St. John in Shropshire were delighted when Colonel West was promoted to be a Knight in the Order - an honour he so richly deserved.

He wa County Commis ioner from 1956 to 1967. For the past 6 years he has been Chairman of the St. John Council Appeals Committee with quite outstanding success, organising Charity Balls , Gymkhanas, 'Gardens open to the P ublic' and numerous other activities which have not only raised large sums of money but also brought St. J ohn to the notice of the public.

J ames West devoted all his energiesand they were very considerable - to the

I AT RANDOM (continued

from page 1 )

Carter, and our people are trained in it as an alternative to mouth-to-mouth, which remains the most effective from a purely respiratory standpoin t.'

MEMBERSHIP

The decline in Brigade membership has become much less steep during the pa t few years and there are many indications that the curve may by now have flattened out and even begun to rise; certainly this is so in at least some Districts and Counties. It isn't easy to analyse the factors which contribute to stemming a decline in membership and promoting an increase; but [ have no doubt whatever that, by and large the greatest success is being achieved in places where the following factors prevail: (a) there is the closest co-operation between the Association and the Brigade branche in teaching good first aid to as mallY people as possible, both among the general public and in indu try; (b) first aid and nursing cour es, whether run by an As ociation Centre or by a Brigade Divi ion, u e the be t possible instructional techniques, involve the candidates in as much practical work as possible and reduce mere listemng to a minimum, making all their practical work as realistic as conditions permit, and a bove all ensure that the candidates never 10 e sight of the fact that they are not learning to deal with 'cases' but with people whose suffering they can help to alleviate; (c) potential recruits to the Brigade are made to feel genuinely welcome and are not given the impression that they are being grudgingly admitted to an almost clo ed hop: (d) newly joined members are not just used as the latest VIctims for bandaging or bed-making, but are at once given the fullest pos ible opportunitie of taking their share in practical work both in training and (in company with more experienced members) on public and other duties : (e) the member of ambulance and nur ing division, and of adult and cadet divisions, even if not officially 'combined', get to know eoch other a friends, occa ionally train together (after all, in real life none of us can pick our cosualties according to our age or sex we just have to take what comes), and share public duties on all suitable occasions; (f) divisional training programme present a stimulating challenge through being imaginative, rea Ii tic, adventurous, and quite obviously related to the circumstances of the 1970's and not the 1890's; (g) and finally, su perin tende nts tud y the talen an d interests of each individua l member and give him or her the fu ll est opportunity to develop and use them in the servi 'e of mank ind through the medium of their Brigade membership 1 think we're often apt to look on recruitment as our 'number o ne objective', which can prove as counter-productive as all other forms of putting the cart before the horse. For surely our prime

Mrs. West has been a tower of strength to him in their joint effort to support the St. John Ambulance in the county. We owe them both a tremendous debt of gratitude and are indeed fortunate to have her as our Deputy County President, in which capacity we feel sure she will carryon the fine work done by her husband.

objective is to teach good first aid to as many people as we can; and if we do the job well, a proportion of them will become sufficiently involved to want to join our uniformed ranks; if they don't, then we'd better look to see what was wrong with the way we put our training course acros

For many years [ was superintendent of a division which had a close liaison with at least two other divisions in the neighbourhood. Each of the three divisions ran an Association first aid course for the public annually, and in most years they each ran a nursing course as well. We tried to stagger these courses so that there was no overlapping, and whenever any of us received enqumes about Association training or possible Brigade membership , we encouraged the applicants to attend the next available course with whichever division was running it. On the whole, tho e who afterwards joined the Brigade tended to join the division to which they first applied, but sometimes they got so involved with the division which ran the course they attended that they joined that one instead. And I think I can truthfully say that this state of affairs was happily accepted without any mutual recriminations about 'poaching'. After all, what mattered most was that we should teach first aid (or nursing) so well that some of our trainees afterward wanted to join the Brigade, and which division they joined was relatively immaterial. I f more divi ion adopted thi policy I'm sure it would not only improve recruitment but would also improve the standard of our training by fostering a spirit of happy and good-natured rivalry!

FACE - LI FT

By the time that you read thi the St. John House Club will have emerged from the hands of painter and decorator. The kitchen, diningroom (including the chairs bought with the anonymous gift that I mentioned in J anuary), bar and Priory R oom, as well a two more bedrooms, will all have had a 'face-lift' and be ready once more to welcome the club's member and their guests. Overnight accommodation during the week is apt to get booked up well ahead, so if you want to be quite sure of a room it' advisable to apply early: but there are often vacancie at weekends, and you might be able to get a booking at quite short notice if you suddenly decided to take the family to London for a weekend and would like to stay in a friendly atmosphere where you cou l d be comfortable at very modest prices. And for tho e who work in London, the weekday lunch at St. J ohn Hou e give you a good value for a basic charge of 3lp (including V A.T.) a you could hope to find anywhere. 0, if you're not already a member, why not write to the Warden at 50 Eaton Place, S W.I. and ask for particulars?

9

Training our Leaders

THE ART OF EFFECTIVE SPEAKING: PART 2

Methods and General Ends Of Speech

R EGA R DLESS of your gener al knowledge or the confidence you hav e developed , a new problem will confront you each time you speak. You will n eed to prepare specifically for ea ch occasion.

To aid in your preparation , and to enable you to improve your presentations , you should be familiar with some of the recognised methods of speech delivery and some of the gener a l ends whi ch might be achieved.

T H E IMPROMPTU METHOD : This method is commonly known as 's peaking on the spur of the moment '. No specific preparation is made for the particular occasion; the speaker relies entirely on his gene ral knowledge and skill. Too often we find the inexperienced speaker risk rambling, incoherent speech which the imp r omptu method so often produ ces.

Although the impromptu meth o d of speech delivery is one of the least effective it does serve a useful purpose in training people to speak effectively. This purpose is identified as developing the ability to think on your feet'.

THE MEMORISATION METHOD:

T h is method is in .direct opposite to the impromptu method . The speech is not only planned but out and committed to memory word for word

Some professional speakers can use this method well, but too often it re su lt s in a stilted, inflexible presentation. Avo id the risk of forgetting a word and spoiling your speech. Memorise a poem or an important quotation but unless you are a professional don t attempt to mem o rise your speech presentation

THE R EADING METHOD : This method is rarely used except for very

This article, published in two parts, on effective speaking is the basis of training employed by American State Police and was prepared by the Los Angeles County Sh eriffs Department Training Bureau It was sent to us by SJA's Hampshire Depu ty County Commissioner R W. Harris , who was Training Officer of Hamp shire Constabulary

formal occasions, and for some types of radio and t e levision presentations . It is prob ab ly the most ineffective method of speech d elivery a nd sho uld be avoided except in special situations. While discussing this method we should m e ntion that important heads of state use this method only because their words must be so exact in nature. For the average s peaker , this method will establish a barrier between him and his a ud ie nce. There ca n be no eye contact whi ch s so important in establishing a per so nal relationship with an audience . If you must, read important quotations and s tatisti cs from your outline, but avoid the pitfall of the 'cold fish' approach ca used by reading a n entire speech from manus c ript.

THE EXTEMPORANEOUS

METHOD : This m e thod is the mo st highly recommended of all methods of speech delivery a nd is undoubtedly the most effective. This s pee ch is very ca r efu ll y planned and outlined, but is never committed to memory. The speaker uses his ou tline to fix firmly in mind the sequence of ideas and to r eca ll to mind the wording which he h as plann ed to use. In other word s, the spea ker uses his outline as a guide a nd not a crutch. The extemporaneous method is alway s best

TO INFORM Your main purpose during a s peech to inform will be to make the a udi e n ce understand some thing , or to widen the range of their thinking. To accomplish thi s, the speaker must provide the audience with enough information, examples and specific data to make his points clearly understood. Wherever possible, the speaker should relate his idea s to the existing knowledge of his audience but he shou ld a lso attempt to point out omething new, or unnoticed before , about his subject mat er ial. This will stimulate interest and attention on the part of the audience and help to avoid dryne s a nd boredom. Rememb er when your audience ceases to learn fro:n your presen tation, they quickly lo se in terest and withdraw attention.

TO E TERTAI : This will be your general end when your primary concern is to have the audience enjoy themselves. To accomplish this objective you will need to avoid heavy discussion and controversia l subjects If you present facts a nd figures during a speech to entertain, they should be striking and unusual. Above all, you must never attempt to 'grind an axe' during a speech of th is sort.

Coming Home

for the novice speaker. He shou ld develop a vigorous, flexible and spontaneous presen ta tion.

As with the methods of speech delivery , there are times when your general purpose will differ when called upon to prepare a speech. Therefore, the good speaker will be familiar with some of the general ends of speech and know how to achieve them.

TO STIMULATE : This will be your general end when you are trying to inspire, arouse enthusiasm, deepen a feeling of awe, respect or devotion on the part of your audience. Seldom is the attempt made to change the beliefs of the audience, or to teach them something new. Rather, the attempt is made to strengthen a belief already in existence.

TO CONV I NCE: This will be your general end when you are trying to influence the beliefs or intellectual attitudes of your audience. The essential characteristics of this speech is tha tit attempts to prove something. A speech to convince is usually filled with argument.

Al so, in many cases, the topic is quite controversial. You must be well supp lied with supporting material such as facts, figures, examples and illustrations when your general end is to convince.

TO ACTUATE : The objective of a speech to actuate is to obtain some definite, observab le performance on the part of your audience. The ba sis for the desired a ud ience reaction may be the creation of a strong belief, the arousal of emotio n , or both. The observable performance you desire might be to vote y es' or 'no'; it might be to contribute money ; it might be to sign a petition , form a parade or simi lar function.

To summarise, be familiar with the four recognised methods of peech delivery, and the five general ends which may be achieved. Remember that regardless of your subject the aim of every speech is to get some sort of reactiOIl from the audience. Your selection of the proper method and your choice of the correct general end will help you to obtain that desired reaction from your audience.

How To Interest Your Audience

A peaker mu t devise orne means to capt ure the ini tial a t ten tion and in terest of his audience. I f this is true then it mu t follow that he must also have orne means of maintaining attention and intere t once he has it. Very little would be gained if, through a good introduction a speaker secured the initial attention of his a udienc e and then released them for the rest of his speech.

What i attention? Like electricity, it is not a tangible thing which can be picked up in the hands and examined. But we do know that it is highly desirable when speaking to an audience, and we do know some of the pecific human factor which bring it a bou t.

We will discuss some of the specific factors whi ch bring about human attention and interest, and learn how they can be applied to one's peech. There are three broad ways to in terest an audience, and we will find that all of the more spec ifi c factors fall into one of the se three categories.

I. Tell them sometliing new about something old: Thi s is one of the oldest and most effective aw of learning. People become interested Continued on next page

WHE ONE TAKES a specialised course, such as the Air Attendant's, one takes it more for interest and a cha nge from first aid and nursing than with the expectation of an opportunity to put the new found knowledge into practice. One a lw ays hopes, of course, to be sent to some foreign part to escort a patient home, but realises that it is an improbability.

My husband John and I took the air attendant's course in 1971 and have since been fortunate enough to be two of 20 people who have taken a course with the Birmingham Fire and Ambulance Service the use of oxygen being one of the focai points of this course.

John has been in the Brigade since he was 17, now with eleven year's service, and I started in the BRCS 13 years ago, when I was twelve, transferring to the Brig ade two years ago. Now you know all about us, I will tell you the story of how all our training, particularly the ai r attenda nt s course, proved very worthwhile.

While boarding the Comet Four which was to bring us home from a Christmas holiday at Tenerife, my husband and I noticed that one of our fellow passengers was being transported to the aero plane by wheelchair. Then we discovered that fate had placed the gentleman and his wife immediately behind us, so we naturally enquired what was wrong and di scove red that Mr. Brown was suffering from a evere attack of bronchitis. It wa fortunate that the seats were high-backed and that neither Mr. or Mrs. Brown aw the anxious look which J ohn and I exchanged. We knew that the four-and-a-half hour flight cou ld prove to be very erious for Mr. Brown s co ndition , so, although our offer of help was , at first, refused by the stewardes es, we de cided to keep a very watchful eye on him.

Almo t before the plane had reached the c rui ing height of 33,000 ft, Mr. Brown 's breathing had become very shallow and he wa showing igns of cyano i . Knowing from our air attendant training that clinical oxygen should be available, we advised Mrs Brown to call the ste wardess and reque t oxygen. The stewarde administered oxygen for the fir t ten mi.nute, but, although she

commented that they were one stewa rdess short, owing to the 'flu epidemic, it was obvious that she re garded John and me as 'keen amateurs' and was reluctant to let us take over. However when one of the stewardesses heard John explaining to an extremely anxious Mrs. Brown the reason for her husband's shallow breathing and dreadful colour, we were gladly left in charge.

Owing to the danger of explosion when the oxygen was in use and to the fact that ciga rette smoke was detrimental to our patient's condition, the 0 Smoking' sign was kept alight for most of the journey. We were surprised and annoyed that some of our fellow passengers selfishly continued to smoke. Because the supply of pure oxygen was limited, the overhead supply, usually used in the event of depressurisation of the cabin, was used. As this was an air/oxygen mixture, it soon became obvious that the pure oxygen would have to be used and the supply limited It was interesting to note how quickly Mr. Brown's condition improved when the latter was used. Taking into considera tion that the oxygen supply was the dry variety and so could be used only for fifteen minutes at the most at anyone time, because of the danger of drying the mucous membrane and causing further complications, the supply was limited and that because of the swelling in his lungs due to infection, Mr. Brown could have easily taken an oxygen overdo e we did not dare to turn our attention away from him.

As the plane began to lose altitude, Mr. Brown's condition improved noticeably. Almost before the plane came to a standstill, a doctor and an ambulance man were aboard. Mrs. Brown thanked u for our help and Mr. Brown had recovered Sll fficiently to gasp his thank too.

When we started the flight, sleep seemed to be the an wer to the inevitable boredom, but instead we pent a very instructive. interesting and rewarding four-and-a-half hour.

John and Linda P icke r in g ( P hoto: Bromsg ove Messenger)

Linda Pickering, Solihllll Transport Division.

Training our Leaders (contdJ

and pay attention when they find they are learning something, but they get bored when the speaker dwells too long on old familiar facts. This factor is particularly useful for a speech to inform.

2. Tell them something about themselves: People are interested in themselves. They attend a speech or lecture voluntarily only because they feel a personal need for the information presented. They are not interested in the personal problems of the speaker. Include your audience in what you say by avoiding the over-worked word T. Speak in terms of WE THEY, YOU and US.

3. Tell them something about people: Because of the human tendency to identify ourselves with others, people are interested in happenings to persons other than themselves.

'What happened to Jones could happen to me', etc.

ACTIVITY OR MOVEMENT: Activity and movement attract and hold human interest. Activity can be built into your speech. For example , if you were telling your audience about a certain machine, it would be much better to tell them how it works than to tell them how it is constructed. Get the wheels to turn and create activity in your speech. Your speech can also indicate movement. Don't d well too long on any given point, but show your audience that you are progressing from an introduction to a conclusion. Use the pause to indicate tha t you are finished with one poin t and are about to move on to another.

REALITY: Whenever possible you should speak of those things that are real. Speak in terms of people, places and events and use vivid, colourful word description. Create a picture of your idea in the minds of your audience. When you refer to a friend, give him a name - even though it must be fictitious. When you refer to a place, describe it. Describe its location, colour, shape and size. Use visual illustrations in the form of pictures, charts and diagrams to add vividness and reality to your speech.

PROXIMITY: Proximity can be built into your speech. A direct reference to some person in the audience, or to some object near at hand will momentarily attract and hold attention. A reference to an incident which is familiar to the audience, or one which has just recently occurred will have the same effect.

FAMILIARITY: People are always interested in those things with which they are familiar but they become even more interested when we point out something new or unnoticed about these old familiar

12

things. If we dwell too long on old familiar facts, the audience ceases to learn and will soon 10 e interest in what the peaker ha to say.

OVELTY: People are interested in those things which are novel. For instance , when a dog bites a man it's a common occurrence, but hould a man bite a dog - that's news. Extremely large or small things are novel and hold audience interest. Tremendous contra t and comparison will achieve the same result.

SUSPE SE: Uncertainty of outcome cause extreme human interest. People don t go to a lopsided football game or boxing match because there is no suspense involved. Thousands of pounds are made each year through the sale of mystery novels which employ this one factor alone.

When you plan to use suspense during your speech, be sure to give your audience a large taste of important information at the beginning of the speech, so they will want to hear more. This is the same principle used in the mystery novel.

CONFLICT: Opposition of forces will always compel human attention and interest For example, a speech concerning the struggle of man against disease denotes conflict. It should be remembered that any subject which is controversial will usually create conflict of opinion and therefore hold audience interest and attention.

HUMOUR: People always pay attention to those things they enjoy. The use of humour during your speech is good because it will tend to relax the audience from tension built up by some of the other factors.

When you choose to use humour however, make sure that it is both relevant and in good taste.

THE VITAL: People will pay attention to those things whi c h are vital to their well being. A referen ce to something which will effect a person's life, health, reputation payor his family will usually cause immediate interest. Even the danger to someone else will attract attention because of the human tendency to identify themselve s with others.

To summarise, the factors of human interest will not guarantee that every speech you present will hold complete audience interest. But through their use, you will find that dry subjects become more interesting, and bored audiences become more attentive, These factors are additional tools for building an effective speech presentation. Build some of them into your next presentation , and let them work for you.

How To Support Your Ideas

Regardless of the kind of peech you set out to const ruct you will always be confronted with this question: llow ca n [ support the sta tements and ideas which I intend to present to my audience? You should be very much co ncerned about this question because there are also two important que tion s in the minds of your audience while you are speaking. They are: Wha t doe he mean by that? and What proof do I have that he is right? Until you have answered these two important questions to the satisfac tion of your audience, you have 1101 supported your idea effectively.

In this chapter we will discuss some of the specific upporting device which will help a speaker to answer these two all important questions to the satisfaction of hi audience.

The primary purpose of all upporting material is to amplify, clarify, or prove a statement. Supporting devices shou ld be used proportionately. That i, don't attempt to build your entire peech around one type of supporl. Sample as many as you can to add variety to your peech.

EXPLA ATIO This a simple, concise way to make clear an obscure term or statement which you intend to use during your speech. When there is doubt in your mind that your audience migh t no t understand a certain term or statement, stop and exp la in it before you continue.

A ALOGY OR OMPARISO To make clear a complex point, connect what is already knowlI by the audience to the thing that you wan t them to learn. Analogy and comparison may be either real or imaginary. Either will achieve the same desired result.

ILLUSTRATION There are two forms of illustration; visual a nd oral. Visual illustrations usually involve the use of pictures c harts , graphs and diagrams. A pi c ture is worth a thousand words so use them whenever you can. There are many times, however, when such aids are not available so we must rely on words to accomplish the ame result. Or a l {llustrations are a detailed story used to support an important point during a speech presentation Like analogy, it may be either real or imaginary with the same desired result.

SPECIFIC I STA CE: Specific instance is a condensed form of factual illustration Jt is never detailed and never imaginary When a speaker refers to an incident as a specific instance it should be something which is familiar to the audience.

And now, let's hope you enjoy giving that talk.

As others see us.

Thi s article, written by reporter Richard Groom, appeared in the Carlisle Evening News last ovember:

Far too many people Loday think that being a member of the St. J oh11 Ambulance Brigade is imply a matter of carry ing stretchers at fooLball matches and wearing old fashioned uniforms.

Such people shou ld go a long to Harraby Comprehensive School in Carlisle on Wednesday nights when the I1ar raby Cadet Division of the brigade is meeting.

Mr Edward Ktlpa trick has been Diviional Superintenden t for the past nine years, bu t he is known affectionately a Eddie, even by eigh t-year-old cadets. He attache great significance to this point. 'The lads get enough of all that 'Yes sir, no Ir' busine at school. H ere I'm simply Eddie.'

ineteen eventy-two i an important year for the cadets, for it is the movement's Jubilee

The Harr aby adet DIvision for boys between the ages of eight and 16 wa founded In 1963. But not all has been plain ailing, mainly through ack of support from parent and the public generally

Lack of support caused the closure of the girl' section in 1970, and the boy' division is at pre ent undergoing a minor crisis.

"We rely entirely on voluntary aid," said Eddie thi week,' and need at least £AOO a year to survive."

"Our basic aim is to see that the young people are gIven an example of a better way of life, and to train them as good CItizen of arlisle."

"SeelJ1g lads grow up and develop makes all the hard work well worthwhile. And there is plenty of hard work."

Aided by two adult assistants, Eddie organises weekly activities for the 60 boys, divided equally into Ambulance Cadets and Junior Cadet. As well as soccer and swimming, the cadets learn how to li [e ave and many other first aid technique. This year animal care ha been discussed and demon trated.

The boys are also encouraged to work in the community, visiting ho pital patient and generally m aki ng themselve of use to the public. Such work, adly, often goes unnoticed.

Eddie also helps boys who have got into trouble. I try to give help when the lad s need it. So many young t ers need more than ju t normal chool and sometimes h a ve to help in putting them back on the rails.'

Such word bear te timony to the worthwhile work of the Harraby adet Division It see m s a pity that the movement does not get the public Support it de erve

The lads of Harraby introduce their annual open night

Head tucked in, legs over plenty of exercise With in · structors standing by

And Instruction - in this case animal care. ( Photos Cumberland Newspapers)

FIRST AID IN PRIMARV SCHOOLS

from Michael J N. New b y, Teachers Cert, Sl a d e Cert, AIHE

Having been introducing young children to various aspects of health studies via biology in my science classes, and, having regard to the fact that most children by the age of eleven have experienced an accident requiring some form of medical help, it seemed logical to introduce them to first aid as part of cience. Since last September we have, therefore been running first aid studies under the direct help of Mr. J Dillaway , of the Loughborough Division of the St. John Ambulance.

The classes are mainly run during a Thursday dinner break. The children range from 8+ to 11+. In addition, we d i d experiment by taking one 8+ class during normal science periods a nd [ h ave experimented by running introductory first aid with mu ch younger children.

All classes are introduced to ba ic fir t aid, how to deal with simple cuts and bruises , as part of a series of studies covering basic hygiene and health. They also study, in appropriate depth, why accidents happen and what to d o if faced with an accident with no other help or equipment nearby: make comfortable, control bleeding, don't move patient, get help qui ckly, etc. From this introduction I hope the children will develop enough interest to want to join one of Mr. Dillaway's groups which deal with the subject in more depth.

At the moment we have two courses one a ba sic praclical course and the other an advanced group learmng theory as well as practical team work. The second group has already finished and passed their basic. Both courses are attended by twenty children and both have long waiting lists . While it is diffi c ult to evaluate long term results, there have been several in teresting developments during the short period we have been running these courses.

I have found that at 6+ the top children were capable of making, for example, a St. John sling better than the wor st in our first aid groups. We are comparing a complete infant class, having had only one introductory lesson , with a selected group of much older interested junior children. Since the infant children enjoyed this lesson a great deal, this raises interesting possibilities. Could , for instance, a few more lessons spread over a year at infant l evel lead to a development of higher skills at junior and secondary level?

The second year class (8+) had a term's co urse during norma l lesson time. With the wider ability range, it was noticeabl e that the results of our first aid test (the same test for all ages 8+ to 11 +) had four 8+ children surpassing the great majority of the older children, obtaining with a few others the second highest marks. It was also noticeable that not only did 34 of the class want to carryon (unfortunately this wa s not possible due to timetable demands and pressure of space), but that other classes in the same year wanted to join in.

In all groups of children there was such keenness that a high percentage of those who failed wanted to not only sit the test again but also to reattend the complete course.

The older children contain a good proportion who wi h to continue first aid when they reach secondary levels. One 10+ child put a sling on his younger sister when she injured her arm and before she went to the doctor. Although there is more interest shown by the girls (one factor here is maturity of development), the proportion of boy s s howing interes t is growing all the time

In combination with our safety studies, there h as been a marked growth in the awareness of situations in sc hool which might lead to accidents. We are therefore starting a rota of first-aid helpers (including the best young children) to help the teachers by dealing with minor cuts and bruises , the leacher on duty checking their work afterwards. In the near future we are planning to start a safety council.

As to the staff, we are busy rectifying deficiencies in first-aid equipment, which although minor left some small gap s. I am planning to attend fi rst aid lectures as soon as time permit s. The parents have shown keen appreciation for this type of work for their children.

READERS VIEWS

Readers views and OpinionS, which should be sent to the Editor , although publ ishe d are not necessarily endorsed by the Editor or the Order of St John and I ts Fo unda tion s Although readers may sign pllbllshed letter s With a pen name writers must supply their name and address to the editor

As a teacher I regard thi exlra work a being of equal importance to anything I have done since 1958 [ therefore hope to study the effects of bringing first aid inlo these level in mu ch furlher depth.

L oughborough

PRE -CADE T GR OUPS

from 1. W. Dillaway, Lay Instructor

Micha e J N. Newby

Since September 1972 I have been engaged in an inleresting project at Fairfield Prim ary School. [n conjunction with Mr. ewby, the science master, I have been giving elementary fir't-ald instruction to groups of young pupils between 7+ and 11+

The introduction to lhe need for first aid was made through the function of the ski n and its importance to the body as protection. Any break in this skin is seriou and mu therefore be treated quickly.

The children were introduced to simple roller and tri-angular bandaging and the practical periods were amusing and rather noisy at times. The enthusiasm, however, was really the surpri ing feature of these periods and the fact thal the children maintained this enthusiasm over nine weeks.

My experience leads me to wonder whether some form of pre-cadet membership of Sl. J o hn might not be worthwhile, allowing schools to form their own groups.

In view of the annual increa e of accidents of all types, at home, at work and a t play , not forgetting on the roads, the need for an increase in the amount of lraining seems obvious. This project has demonstrated to me that one solution to the problem of shor tage of ad ult first-aiders is t o catch their intere t while they are young ; as young as 8+ perhapsl

Lough borough

NEW COMP ETITION ?

Feb 73) but their ambu lan ce competition held in October 1972 is not th e first competition of its type to be held by St John in Br t a in As long ago as 1969, the Eastern Area of London District began arranging such a competit ion and the first one was staged by the Area Competition Officer Mr. L. Webb in May 1970 , with six ambu lances and crews. Sin ce then the competition with slight modifications has taken place each year with five or six crews taking part.

We were surprised to see how similar the four sections of the Farnborough competition were to our own, and can only assume that the St. John grapevine is very healthy. Our crew test last year consisted of removal and lransport of an elderly, disabled coup le from their home, a common job for Brigade ambulances.

If any other Area or Division would like advice on running such a competition and an outline of our rules and tests , A/S/O L. Webb 69 Chadville Gdns Chadwell Heath, Essex, will be plea ed tei upply the information.

London, 1:::6

CAD ET ANNUAL?

from Mr s. E. Treagus, Divisional Offjcer

E. A. Fisher

GIRLS' U IFORM : White hat with peak and SJ badge; white dress with side zip, 3 SJ buttons from reverred neck to waist, with sligh tly flaired skirt; belt of dress material fastened with one SJ button; SJ fla shes on sleeve s; SJ cross embroidered on a pocket on left breast patch pocket on right side of skirt; white knee ength socks; shoes black or white.

PR I O RITIES

from Edward Tortell

J W. DillalVay

from E A. Fisher, ASO I am sorry to di sappoint Farnborough Division (page 7, R eview,

Would il not be a good idea for St. John to have a cadet annual?

Such an containing first aid and home nursing stories, and St. John events over the past year, would make an excellent birthday or Christmas pre se nt and so encourage youngsters to join the cadets, which could only mean more strength for the Brigade , ultimately.

Lewes, Sussex E. TreagLls

A TTRACTIVE UN I FO RMS

from F. C. Hartley Centre Secretary

I was most interested to see the attractive uniforms being worn by the new co mbined cadet divi ion in Cypru (page 21, November Review).

Would il be po sible to include a more detailed photograph in some future issue?

Cape Town F. C. Hartley

EDIT: Mrs Frieda Cox, C/O HM Customs, RAF Br ize Norton, Oxfordshire , the founder of the first SJ A division in the Sovereign Ba e Area, Cyprus (referred to by Mr Hartley) , sent me this more detailed photograph of the cadet uniform and the following description. Mrs. Cox sends best wishes to SJ A South Africa and would be delighted to hear from them

BOYS' UNIFORM: St. John black beret with badge ; white shirt with SJ flashes of county or country; SJ tie: grey trousers with SJ belt; black shoes; white haversack.

The Cyprus SJA Commissioner meets those attractive uniforms

I was very pleased to read Col. Ollerenshaw's letter (Jan. '73) and feel perfectly satisfied with his explanation, but regret cannot agree with his accusation of my using an obsolete handbook because so far we have had only the 2nd edition available here and we still have none of the 3rd edition in stock at Malta Brigade shop. Fortunately have since g ot a copy of the 3rd edition from a friend in the UK and I wish to take the opportunity of expressing my complete satisfaction at the fact that my contention in choosing priorities has now been confirmed by the 3rd edition. I also wish to congratulate the Surgeon-in-Chief for the production of an excellent and much improved edition. Regarding the description of an incident involving the priorities , as suggested by Col. Ollerenshaw, I would like to state that the nearest I got was the case of a man falling through the wooden floor of a big stage during a pageant show; his right femoral artery was severed and he was stuck between the jagged edges of the planks just below the ribs, thus impeding the movement of the diaphragm. My first job was to get below the stage and arrest the bleeding by applying a pad in the groin held in place by a bandage tightly tied in a figure of eight round thigh and waist; this may be very unorthodox but it was the best I could do under the circumstances, when digital pressure was out of the question. Afterwards I immediately raised and supported the patient at the same time giving instrucrions to helpers who rushed to the spot after my call for help. The man was given mouth to mouth resuscitation even while being released from this awkward position. He survived.

Malta

R EP L V I NG T O

from Miss K. D. Wilson

Edward Tortell

M. W. Harris ( ovember Re view) suggests that lay instructors should be exempt from the annual re-exam in the Brigade. [ agree giving lectures keeps one up to cratch but do not think that taking a re-exam with one ' s own class or division necessarily leads to loss of dignity (unless one fails!). It can let members see the instructor , officer or SR is willing and able to take the exam, and po sibly boost morale.

And assure Mr. Moring, who commented on recognition by members and officers of his professional status (ie holding a Miller cert ificate), that very often nurses and doctors are not recognised either (he assumes they are) despite their red or green bars or piping on their uniform - whether by accident or ignorance of rank markings and flashes, 1 don't know.

Workington K. D. Wilson

PEN PA LS

from Mrs Leslie A. Sinclair , Sec/Treas

In a recent issue of the Review 1 noti ced an ap peal from a Cadet Division for pen-pals in order to qualify for their International Friendship Pr oficiency Badges. [ brought this to the attention of our Stratford 305c Cadet Combined Divi sion and immediately they asked if 1 would have the same appeal made in the Review for them, as follows: Pen-Pals wanted from Au tria, Ireland , France, Brazil, Belgium, Bolivia , China and Kenya

The language of our cadet is Engli h only , so the correspondents would also need to be familiar with the English langu age.

12 of our cadets have answered the earlie r appeal mentioned above and we are looking forward to many interesting letter from England also

PO Box 783, Stratford Leslie A. Sinclair Ontario, Canada.

Better to die livingthan to live dying

A TALK BY MRS WENDY MITCHELL, SRN , SCM (See A T RAN DO M March 1973 issue)

AS YOU WILL probably have noticed, my name carries after it SR , SCM. I would however like to point out that J am in no way involved in that respect with the care of the dying. My job is very much in a part-time capacity as a grass-roots midwife preparing mothers for birth, and I am sure that is not the reason that I have been asked to speak today. It is because [ have had experience of local government and therefore of the organisation of the services so needed for the care of the dying. I start by saying it is better to die living than to live dying. I think in consequence of this that the needs of the dying are very much those of the living, and every resource should be made available to all who want to die in their own homes. None of us should deny that right if it is humanly possible. I think most of us would far prefer to die surrounded by familiar things, by the people we know and love. I have been told that I am far to idealistic to hope that aU who want to die in their own homes can be catered for. Idealistic T may be, but we must strive towards it, otherwise apathy will allow a less ideal situation to prevail.

We know that fear of the unknown is one of the most difficult problems of the dying patient, and the tender loving care of the relatives and the understanding of the domiciliary supporting team - without intrusion, I would stress - can make this perhaps an easier problem to contend with. We have heard today about areas of excellence. I know the normal expression is 'centre of excellence', but I happen to know that although I do not live directly in the area of which St. Christopher's is the centre, r am in the area that their arms stretch out to. So I am very well pleased that if ever I am in the position of needing help I know where to go.

There are centres w here such excell en t care is not given. There is, for example, much criticism of domiciliary care, 16

Mrs Mitchell is a member of Ihe Central Health Sen 'ices COl/ncil: forlllerly chairmall of lite Healtlt CO/lll/1lttee alld Jlice·chairman of tlie Social Secllrit) CommiTtee, Londoll Borollgh of Greenwich.

understandable because from area to area it varies tremendously. The ational Council for the Single Woman and her Dependents did a survey some time ago which showed up just these variation I thought originally, when I sat down to write this, that in 1974 when the reorganisation of the health services takes place these problems will be -C11red. Unfortunately a lot of dying people are going to need the up port of the domiciliary team before that date, and proposals mu t be made for a reliable service after that date.

I would like to talk about the orga nisa tional domiciliary team as 'Cogwheel Care of the Dying', because that is how I see it. Various disciplines participate. There must be a drive wheel to set the train of cogs in motion. The cogs as I see them are initially the hospital, nursing and medical social work team. They know the present and future needs of the patient. The local health authorities: they have the facilities to provide for certain of the needs. The General Practitioner, providing medical care and support for the family. The social worker and the voluntary services, who playa very valuable supporting role. These as I see them are the cogs to be set in motion. The drive cog, however, must be somebody who can be ea ily contacted by the hospital and told of the patient's discharge, who can visit the home and assess the problems and the needs of the patient and family without intrusion, and then can set the train of cogs in action. Someone not only with the medical knowledge but also the knowledge of social work. A member of

the caring team who has the necessary experience could well, in my opinion, be the health visitor. In many areas she perform this task already for geriatric patient, and to extend it to the care of the dying seem logical. She deals with the family in its infancy, and may already have had contact with the dying patient a a child, as a young member of a family, as a mother or father. Perhap one of the most disturbing things about our present service i the lack of com munication between hospital and domiciliary team, between ho pital and GP, and sometimes between GP and other members of the caring team

I have been told that there are many area where it can take several weeks to 3 months for a letter to reach a general practitioner from a ho pital telling him of his patient discharge Some GPs have mentioned that there have been tIme when they have not received a letter at all, and one GP tell patients to let him know when they have been discharged becau e the normal channels of communication frequently break down

Another I was speaking to only yesterday has just received a letter telling him his patient had an operation a year ago. He also told me that he reads the obituary column Jll the local paper each week to see if any of his patient have died, since the hospital does not always inform him and he knows the family will need him It is also significant that in talking to people directly involved with the care of the dying I was told by one general practitioner, that he thought he was the one who should organise the services at home [was told by a ward ister that she was the one who found herself having to do il. [wa told the same by a di trict nurse supervisor, who often heard of the need for care from neighbours and local tradesmen. A medical social worker found that she had to do it. So many people are involved, but no one is given the ultimate responsibility for care.

For domiciliary team to work effectively and efficiently they must be told in advance about the patient's need. This I consider is absolutely essential. A phone call from the ward sister to the general practltioner or health visitor can start the drive wheel. Having assessed the needs by contact with the patient the hospital and the GP by visiting the patient's home and by talking to the reL.ltives one S made aware of what is needed. Arrangements can he made for what is necessary from the local health authority such things a s day and night nursing services; perhap help from the Marie Curie Foundation with cancer cases; a sitting service ; a laundry servi c e ; Meals on Wheels if provided by the local health authority, all right but if not from the voluntary services; bathing ervices and disposable dressing service; loan of spectal beds or physical aids: from the Social Service Department arrangements c an be made for home help and the so vuluable social workers' supportive help any adaptatlOn to the home that lS necessary can be made before the patient' di charge.

Perhaps one can make the point here about how desirable it lS if the relatives can be given :1 re every so often, so the patient should go back into the ho pital or wto one of the local authority hostels for a while

I know that many of you may well be thinking that half the e services are either non-existent or scanty in your area, and this i why I stress the importance of the 1974 reorganisation. I feel that Area IIealth Authorities must be told that they are expected to provide a certain laid-down minimum for care of the dying, and, if [ may ay 0, for the incapacita ted. (I nciden tally ,I find 1 very difficult to differentiate between the

clying and the incapacitated. At what point do you die? I know we have said this hefore, and I know Sir Keith this morning said we were not thinking of the pre-terminal phase, but if we do not think of the pre-terminal and the terminal together people are likely to fall through the net, and it is perhaps in the pre-terminal phase that they need the help so desperately, even more perhaps than in the terminal).

The local authorities should be told that their social service directorates must provide a certain laid-down minimum of services req uired by the Area Health Authority. This is so essential now that home helps have been taken out of the health field. I feel it is somewhat sad that some of the services so essen tial to the need of the dying have to compete with roads and libraries for finance from the rates. Having been the chairman of a Health Committee, I have had the experience of having to argue for what I considered were essential services against the cases put by my fellow chairmen for perhaps libraries , or roads, or whatever it was 1 found I never knew the strength of the case they were putting up.

There must be a national standard of service It must not be 0 patchy that if you live, for example, in one London borough you can get all the services I have mentioned, but if you live around the corner or across the road in another borough you can get hardly any of them. This to my mind is absolutely criminal.

When someone dying there should be adequate supportive services to enable that per on to be looked after in his own home, jf that is what he wishes. If the supportive services are available the family will feel better able to cope a dying relative at home and be more prepared to do so.

THE NEW SJA GIRLS OF LYDD

J consider that the voluntary services have a much greater role to play 111 care of the dying than perhaps many professionals think. It has already been mentioned that St. John A mbulance and the British Red Cross, who work in the nursing field and have various schemes including the new BRCS scheme training beauticians to work in hospitals, playa considerable part. r should like to mention here that when the possibility of introducing a beauty salon into St. Luke's was mentioned this morning somebody next to me said 'How about men'. Perhaps we can say now that maybe we should think about that problem.

The WRVS with their Good Companion and Meals on Wheels schemes are also an invaluable supporting group. Some organisations such as the Society of Compassionate Friends perform a completely different but vital supportive role in the care of the dying patient and relatives - mainly with children, but I know that if they are needed they extend to adults as well. Here perhaps one mention the work done by the church, because the society I have just mentioned was developed by the work of the Reverend Simon Stevens. It was regretted earlier that the clergy do not go into medical schools. I know that he has been into two medical schools recently lecturing on this subject.

All these organisation and many others like them tend to work in isolation and with little communication with each other in some areas. Because of this and for the good of the community which they so ably serve, there is a need somewhere to tie the strings of communication.

At the moment, voluntary services are brought into the picture of the care of the dying or the incapacitated by their

volunteer f o r ce s r eli a bl e, a nd perhaps this h as been beca u se they h ave not been all

wed to p a rt ic ip a t e t o the full extent of t h eir ca p a bil i ti es. If th e vo unta r y servi c es co -o rdin a o r k n o w s the capabi -

AS COMMANDER (BROTHER )

Surg R -Adm " Cy ril La ws on T ai t McC lint oc k ,

OB E, Q HS , MRCS LR C P (Ha n s)

Sy d ney John Maya ll ( He refo rd )

E dw ard Willi a m Geo rge C u ff (Dor se t ) F ranc s Denni s Kee fe ( Lond on)

Hora ce Geo rge Da wki n s Bu sto n (Warks)

AS OFFICER (BROTHER )

Henry Murr ay F o x, MA (Lond o n )

William Ralph Ni c ho lso n F ri el , MB ChB, FRCP , DPH (Wor cs)

Surg , Capt. Ron a ld S tewa rt McDo na ld , Q HS, MRCS , LR CP ( Ha nt s)

He nry Willi a m Kemp (Essex)

Li o ne Je sse R us t (G o )

Ern es t Hartl ey Barre tt (G lo )

Norman Harry Hea ve n (Wilt s)

Pet e r Har fo rd Cave, BM BCh (C amb s)

Geoffr ey Sp ence r (Lan es )

Willi a m G eorge Broo m ( Dev o n )

Ja c k Jon es Matth e ws ( Gl os)

Th o mas Kenn e th Jam es Leese, MB, Ch B (Lane s)

Mar c us He nry Pin ch (La nes)

Fra nk Crou ch ( Nott s)

Jam es Al exa nd e r S mit h, MB , Ch B (Lancs)

AJtred Henr y Burd e tt (K e nt )

Maj Rabindr a na th Da s Ch o udhur y, MRCS, LRCP DPH DlH DMJ (La nes)

Willi a m Henr y R pp er (S urr ey)

George Willia m Sand e rs (Leics)

Eri c Charl es Claxto n, OB E, F ICE ( Her t s)

Major Ron ald Stu art Kin sey of Ki nsey (K ent)

AS OFFICER (SISTER )

Th e Lady Mar y Holb orow (C orn wa ll )

Olivi a Dor ee n , Mr s. Po tt s (Co rn wa ll )

Flor e nce, Mi ss And e rso n , S R N, SC M (York s)

Mary , Mr s Lave r , BA (Sco tl a nd)

AS SERVING BROTHER

Lt. Cdr. John Arund e ll Hold swo rt h ( Dev o n)

iti es of th e peo p le invo ved, she or he can ass ur e t h em t h at th ey wil l be useful ly e mpl oy ed T h ere are m a n y people in th e co mmun ity w h o ha ve specia l q u a litie,. Al t h o ugh they do n ot wa nt to join any of th e orga n isatio n s such a I have me nt o n e d , they would willing l y app l y to the volu nt ary services co-ordinator. It may be on l y ca ll ing i n to ee a dying patient once a wee k , pe r haps giving e n courageme n t in a particu l ar interest o r h obby that th at p atie nt has, A s I h ave said, we must not only cater fo r prac ica l n eeds , Li fe, w h e it is the r e, m u t be wort h living. [ fee l t h e p rofessiona s must give encouragement, a n d pe r haps in- ervice training for the vo lun teer who ha 0 much to give in this f el d. T h e vo l unteers have got time. Time to listen. Time to sit with the k n ow ledge that what they are doing is worthwhi l e. S ometimes, as I have said, in a less practica l se n se they have more to give the dying patient than per h aps the professio n a l with many others to care for. In summing up, may I say that [ feel the health vi itor has a very real role to playas a drive wheel in the org;l11isati()11

of ca r e, and I h ope t h a t they and th eir m ed ical co ll eagues wi ll seize t h is opport u nity. Th eir co-ordina ti on of w h at I li ke to call t he Cogw h ee l team, w h ic h inc lu d es vo untary services, can bring a c lear-cut respo n sib ility to a group of peop le we ll placed to give the be t possib e domiciiary care for both patient and relatives before death, and after death to the re latives.

T h e Area H ea th A u thority must have a set - up which doe no t allow for a breakdown of communication which can cause physica l and menta suffering to patients and relatives, It would be ideal if perhaps the Marie Curie F oundation had a branch which cou l d give support to the local authorities for patients who are not sufferi.ng from cancer. I know in fact that in some area they do just this, bu t I know that it is not part of their rea l function.

r hope I have managed to describe an organisation for the care of the dying which will enable them and their relatives to say, ' It i better to die living, than to live dying',

Ir e ne Ma ry, Mr s. Bosworth (Leics)

Edna Mill icent, Mrs. Fol lows (Kent)

E izabeth, Mrs. Connor, SRN, SCM (Lancs)

Doreen Mary, Miss Lamming (Lines)

Al ice L ill ian, Mrs. Olney (Il erts)

Margarct Mary, Mrs. McKenna (Lancs)

Li ian Kath leen, Mrs. Baker (Sark)

Harol d Davi d Ada ms (L anes)

All an Pa u l Merrifield (Essex)

J oseph Foley (Lanes)

J ack Hen ly (Sus ex)

Geo rge Percy Po t ter (Yorks)

Co mman d er Haro ld Hodgson (Herts)

Br ian Edwin Hiakeway (Worcs)

Geo rge Will iam Tho ma, (London)

J osep h Marrow (Lanes)

Wa lt e r Her ber t Ell erby (S urrey)

AJfr ed Hu fton (Yorks)

Henry Fi t t (London)

Br ig_ Alan Henry Fernyhough, CBE, MC (Hants)

H ugh Will iam Appleyard (Lanes)

Cedric William Sheppard (Lines)

Howard Sydney S tephens (Surrey)

Norman Percy Sharp (Warks)

o rman Albert Wood ru ff, F IAO. (Surrey)

J erome Vi ncent Lew s ( Yo rks)

R o na ld Wi ll iam Ma ll e tt (Cornwa ll )

Dav id Wasse ll Smith. MRCS, LR CP, DA ( Lon d on)

Alan Scott ( Yorks)

A nt ony Maxwe ll Reade r , MB, BS, 'vIRCS,

LR C P, DObs, RCOG (Sussex)

Pe ter An t hony Fawcett (Surrey)

Haro ld Wa tson (Yo rks)

Go r d on Ru eben Haro ld J enner (Wo rcs)

Sy dn ey Geo rge Rand ( L ondon)

E ri c Har ris Bishop (S ussex)

Geo rge Den is Boynton (Yorks)

A fre d Roy Davenport (Leies)

J onathan Mack (Norfo lk)

Cyri Wi ll ia m Toovey, M BE (ller s)

Les li e S tephen Evere tt (Ken t )

Dav id Alfr ed Du but (Lincs)

Basil Ll oyd Bis ley (Micldx)

S e p hen Dona van Harr ison (Yorks)

Lio ne l Go rd o n Robe rt s (Nor t ha nt s)

Maj. Re gina d G ilb e r t Be van E vans, MBE (Lon do n)

A bert Edward Upton (Essex)

Cyril icholls (Notts)

Barrie James Fus,wrd (Devon)

Harry George Burdett ( orfolk>

AJbert Ballard (Warks)

Hubert Waters (Yorks)

ReglJ1ald J ames Dean (Some rsel)

lI enry Flower Alfred I lobbs (London)

Wilfred Donald I Icath (Warks)

Arthur Samuel Johnson, 1B, hB (StatTs)

Leonard James Jeffrey (Yorks)

Dcrck John l l ilis (Su ffolk)

J ames Charles Linnard (Cornwall)

Geoffrey J ames Green (Yorb)

I:.d\\ard orman Ayre, (Sussex)

Frank Stanley James C over (Wilts)

John James Mallen (Nolts)

Cha rles Sim pson Les ic J ones

Les l ie Thomas F rederick Jones (Leics)

Herbert Frederick Saunders (London)

AS SERVING SISTER

Dorothy Betty, Miss Greenhatf (Burningham)

Sylvia May, Mrs. Bottrill (Cheshire)

Kathleen Mary, 1rs. Downs (Derbys) !-reda Anne, Mrs. Sharp, SR ,R eN (Devon)

Vera, Mrs. Stan ey (London)

Dorothy A lice, 1rs Claph:Jm ( Il ants)

E t he l Mary, Mrs. Wieck. ( Il erts)

Kathleen, Miss Ormerod (La nes)

Dorothy Li ian, Miss Rofe (Kent)

Sheila Mary, Mrs , DIxie, SRN (Il erh)

Winifred Gladys, Mrs. arsh ( I-tanh)

Agnes, Mrs. Crook (Lan es )

Kath leen Ada, Miss (Leies)

Betty Marion, Riordan (London)

Constance F rances, Mrs, J ewiss (Kent)

Agnes, Miss Tongc (Lanes)

Daisy, Mrs. Kent (Hants)

R it a, Mrs, Vere- Kennedy, SRN, RMN (Li ncs)

Maureen Sy lv a, Mrs, Lewsey (Kent)

Joan Brenda, \-t rs. De La COllI (Jersey)

Joan Mary, Mrs. Leese, SRN (Lanes)

LIFE SAVING MEDAL (In Bronze)

Corp R. Blanchford (Guernsey)

FILMS

FANCY SENDING THEM AWAY (Colour 24 mins ) Free loan

D is tribut e d b y Dr , Barn a rdo 's, 18 St e pn ey Cau seway, London , E 1.

T h is film how the Princess Margaret Schoo l for H andicapped Children near Taunton and the philosophy and facilities of that estab lishment.

The panel considered this an interesting well-made film that gives an optimistic view of a positive approach towards needs of handicapped children; the insight towards correct attitudes to the e unfortunates is noteworthy, This film acquaints the public with one facet of the work of the Dr. Barnardo's Organisation, Audi ence: Universal but specifically to those interested in social welfare,

AS OTH E RS SEE YOU (Col. 16 min s.) Free loan

Di tribu te d b y Unil ever F ilm s, U n ileve r H se, L o nd on, EC 4

The 'teen are an anxiou time, when young girls first want to look attractive but often lack self-confidence and the skill to put their ideas into practice. A group of pupils discuss their difficulties and general rules are suggested for body care, diction and posture.

The panel considered this a good film of general Health Education interest to young girls. It stres es the value of old-fashioned soap and water at the expense of alternative well-advertised product.

Audi ence: Could be Llsed as a filler for film shows to ursing Cadet Divi ions.

ENGINEERING IN MEDICINE (1972) (Col. 16 m ins. )

Free lo a n

Di tribut e d b y: Centr a Offi ce of Inform a ti o n London SEI

Shows how the doctor and engineer working in partnership, are helping to raise the quality of treatment and rehabilitation in various branches of medicine and surgery.

The panel considered this to be an excellently produced film that succeeds in its task of emphasi ing the rai ing of quality of treatment in rehabilitation. Its story line is impeccable, production qualities first-rate and its commentary good. It is notable for a constructive quality that gives a message of hope to likely amputee,

Audie n ce: Specifically to patients likely to undergo rehabilitation and to all working in thi field. The film is intere ting enough to be screened to all types of audiences.

THE BLOOD (1945) (B & W 16 min s ) Hire

Di s tribut e d b y: Nati o n a l Audi o Vi s u a l A id Libr a r y, Pa x ton

Pl ace, G y p sy Rd Lond o n S E27

The circu lation of the blood, its compo ilion and it function in suppor t ing cell processes is described.

Correction

I n the February 1973 St, John R eview under Order In vestiture, serving brothers, Mr A, W. Sellars was given as of York, but he lives, in fact, in Derbyshire and is connected with the orth Derbyshire

The St. John Ambulance Film Appraisal Panel, which meets fo rt nightly at Headquarte rs, consists of doctors, nurses, first aide rs and visual aid ex perts who offe r thei r se rvices for this important as pect of visua l aids. Reviews of films appraised by the Panel a r e regula rly

by

'I

A

The

The beginning is confusing but the historical ta

are of great interest; the model work and cinematography is first class but the background music over-powe r ing A ll in all a

to specialised audiences.

Audi e n ce: Mainly medical and nursing students for backgrou n d information.

HARAMBEE: THE WORLD O F THE AWARD (1 972 ) (Col. 27 mins .) Hire

Dist ribut e d b y: The Duk e o f Edinburgh 's Award Scheme 6 E ato n G a t e, L o ndon SWIW 9B N,

This film shows 34 participants from 16 different countries who went to Kenya in 1971 on a community service expeditio n , and how young people come together in a spirit of servic e

The panel was enchanted by this p r oduction; it is educational, interesting, entertaining, with beautiful photography and an excellent commentary_ It avoids, too, obvious pitfalls such as elf-righ teousness. It require, nay demands, general screenin g not only to all St. J ohn Cadets but also to all Y outh O rg anizations, A ud ie n ce: Universal. All St. John Cadets should see this production,

PRESCRIPTION FOR LIFE (1967) (Col. 50 mins. ) Purchase only

D is tributed by : Vi c ker s Ltd ( Medic al Engineering ) Priestley Rd ., Basingstoke , Hant s.

T h e training and re-training in resuscitation of medical an d para-medical personnel. It details the A, B, C, of resuscitation with demon trations, lab-work and dramatic enactment of official cases.

Donald Edw ard Gautr ey ( Ha nt s)

Pe r cy Blunt, MB E (Durh a m)

18

J oh n Pe ter S tockwel l Whi tehead, MRCS, L RCP, MC Pat h ( Yo rks)

Alfr ed Ern es t Payne (Wores)

No rah Annie, Miss Whealc ( ll creford)

Ol ive, Mrs. F room (tJants)

F o rence, Mrs Morrish ( loW)

T h e s u bject matter ca ll s for, nay demands, colour photog r aphy , W ith a poor commentary, strident narration and scrappy animatio n , this film is date d enough to ugge t withdrawal from circu ation.

Audi e nc e: lot recommended.

The panel considered thi a good film that emphasizes the need for 'ardio-pulmonary resuscitation techniques. Made some 5-6 years ago the techniques portraye d are still va l id althou gh chest thumping is not portrayed. Actual cinematography of real life re uscitation cenes is valuable. T h e first half or three quarters of the film is extremely valuable for first-ai d er but the last quarter, dealing with intensive care unit resuscitation procedures including ventricular fibrillation and en d otrachea intubation, are beyond the cope of first aid, The film i lengthy and a hade American for viewers o n e th e less, it is an informative tech n ica fi l m that will be of great va lue to what used to be termed, 'advanced fir t ai d ers' Audi e n c e : Medica and nursing profes ion and stu d ents. I nd u strial first aiders, ambulance personnel an d the first 30 minutes of the film to first aiders.

NEWS from SCOTLAND

Member s of the Order and the Cru sa der C ruise on SS Uganda.

TH E FLIGHT from Edinburgh to Gatwick was uneventful, but the connection to Naple ran into a sharp thunderstorm over Lake Geneva though all of us were too busy 'being British' to show our feelings! aples Airport was in the grip of a strike, but schoolboys, young male passengers and ship's officers carried our suitcase to the airport buses. The sight of our ship, the Uganda, her deck s brightly lit, was welcome and the c heerful greetings of the officers, who to some of us were o ld friends, made all of us feel at home. A force 9 gale blew up during the night we sailed, but by lunchtime on the following day 'those whom we had lost lon g since awhile' courageously reappeared with the sunshine, which s tayed with us for the rest of the cruise.

We , the 'in dependent cabin passengers', soon got to know one another. Th ere were contingents of English farmers and their wives, of Canadian educationalists , a few directors of education and univer sity professors from Scotland and, of course, our group from St. John. We were deliberately scattered about at mealtimes. My particular friend and I with three ladies from Sheffield were placed at the table of the Administrative Pur ser. We literally laughed our way through the cruise and between us took part in everyone of the shipboard activities. There were also cocktail parties to which we were invited and those of us who had birthday parties were given delightful and wholly unexpected presents while the ship's pastry cook baked wonderful cakes. The le ctures on Malta Mycenae, Athen s, Old Corinth , Rh odes, Dubro vnik and Veni ce, given either by the ship's He admaster or by one of his deputy H eads, were excellent academically and very helpful ; and the vanous sessions on the history of the Knight s of the Order of St. John of Jeru salem were well -presented and were appreciated by everyone no matter how know ed g eable they believed them selves to be. Most passenger s went on the arranged excursions. Valletta and the sland of Malta were thoroughly explored especially the co-cathed ral, the Tarxian Temples, Mosta, Sliema Rabat and later 2 0

the Golden Sands, St. Paul's Bay etc

We sailed from the Grand Ha rbour with a better under tanding of why the Kn ights under the great Jean de la Valette, who gave his name to Valletta fought so well to save that outpo t of Christianity.

Our next stop wa at Nauplia, from where, after a look round the Pal amidl Ca tIe and the town, we made for Epidaurus in - the home of the ancient God of Medicine and Healing and climbed up to the great theatre in its beautiful sylva n setting. A hig hlight here was the inging of five young schoolgirl from Staffordshire, who stood together at the very centre of the theatre-orchestra and sang 'Amazing Grace'. Hearers were m u chi m pre sed by the excel len t acoustics of this 2,200-year-old theatre which eats 17,000 people without difficulty We then visited Mycenae and en tered King Agamemnon's P alace through the famous Lion Gate between the Pyramid mountains that foxed Schlieman for so long; and we walked up the road to the Beehive Tomb The Treasure of Atreus - marvelling at the meticulous placing of the huge stone blocks so carefully bonded together. When we emerged from the darkness of the tomb it was breathtaking to see a beautiful red-berried berberus ba king in the bright sunshine against one of the sand -co loured pyramids.

After Old Corinth and the canal we visited the Athens Acropolis, Mars Hill (where St. Paul once stood), the OlympIC Stadium a nd Hadr ian's Arch. We were intrigu ed to see green carpets laid here and there on th e promenade [or children to play on without dirtying their clothes

On e af ternoon some of us took the long bus ride to Sounion and the Temple of

from which to look down on the old walled city. Presently we descended into the town, visited the monasteries with their pleasant garden s, and walked in the l ove ly traffic-free streets. We lll1gered in the cathedra of St. Blaise , resting a little to enjoy its beautiful pictures and stained-glass windows. From Dubrovnik waved off by the customs officials, sailed for Venice which emerged out of the mist on the second last day of our trip. Everyone here took full advantage of the chance of buying presents, choosing things not availab le at home But eventually good byes had to be said, exchanged and promise s to wnte , se nd copies of this or that snapshot or to meet and sail together again. The cruise was over, but it will be spoken of for many day and all of us, no matter from where we hail, Will be loud in our praise of the hip, her officers and crew.

[t was a very worthwhile 'crusade'

Some of the St. John group at the Theatre of Epi daurus Greece

Poseidon. We cots were interested to learn that Athens and Scotland share St. Andrew as patron saint. To mark his day ( ovember 30) our guide pre ented us WIth lovely white, sweet-scented Athens roses from the garden of the Agamemnon Hotel where we drank sweet Turki sh coffee.

Our nexl port of call wa Rhodes We rambled through the St. J ohn H ospital, the Apothecary, the P alace, the Street of tile Knights and the Old Turkish part of the town I will always remember the delicious lemon drink'> we had under a bIg 'village' tree , where the many caL and kittens were so friendly. The following days at sea en route for Dubrovnik were spent photographing Islands, birds elc., but two events will remain long 111 memory. One was a service conducted by a passenger who had been the wartime padre on 11 IS Bonaventure, sunk in the Battle of Matapan. It was held a sunset near the spot where the battle took place. 'Uganda' stopped, the Union Jack flew at half-mast and the captain, officers and men were grouped round the 'pulpit' and the padre. It was most impreSSive and for me the words 'for those in peril on the sea will now always have a deeper signifIcance. A wreath of red poppies was lowered over the ide of the ship into a sea in which were reflected the last rays of the sun. The other was a ch urch service held on deck off Santorll1i in bright sunshine for a congregation wearing summer clothes and sun glasses a nd deep in deck chairs. The captain's mini organ accompanied the singing. Dubrovnik proved to be another delightful port and for many of us a first visit behind the Iron Curtain. Our guide, a true lover of his country, explained everything to us as we climbed to a high point

The roofless remain s of the 13th -c entury Templar church at Temple, referred to in Jan uary's News from Scotland

G. J. Graham ( Edlllburgh )

OVERSEAS

FIJI

The St. John Ambulance headquarter, in Suva qUIetened la,t October as the of Its operntions ,hiftcd to ausori to help hurricane VIctims.

The \ervicc departed to operatc from ausori PolIce Station with the St. John Lieut e nant-Colonel George :-'Iate, in cha rge

A St. John spokesman said most \\orkers had gone to to help nood victim,. Broken telephone communIcations between ausori and Suva were hampenng tilelr efforts. lie said Sl. John workers were mainly concerned 1IIIh tramporting refugees a nd supplies.

JAMAICA

\Iajor R. A. Couche, the Chief Traming Officer for SJ A OntarIo, Canada, recently ,pent three weeks \I ith St. John Ambulance , JamJica

The aim of the visit, arranged through the courtesy of the St. John Council for Ontano , wa to update lo cal lecturing techniques and to

Jet Ball - a new game between SJA Dunedin a nd the Fire Brigade The teams - and the ref (below right) seem to have had a right old time of it

advise the Jamaican National Headquarters on first aid training in general.

\Iajor Couche spent 2 weeks in Kingston concentrating on training potential lay lecturers drawn from the Jamaica Defence Force the Constabulary, tile Prisons Department and the Fire Brigade ; a l,o with civilian lay lecturers.

The last week, Coudle Visited other area in Jamaica, meeting area committees lay lecturer s. St. John Ambulance, Jamaica , are most grateful to their fflends in Canada for making this valuable visit possible

.. Major R. A. Couche, Ch ief Training Officer for Ontario, Canada, and a fi rstaid class In Kingston, Jamaica

NEW ZEALAND

During Dunedin' s Festival Week 73 (Jan 28Feb 5), the \fetropoLitan Fire Brigade challenged a combined SJ A Association / Brigade team to a game of J et Ball. The teams consisted of fOllr men to each ide with the Fue Brigade fielding extra men to man the pumps (a h;ndy situation when their side was 10 ing). Dres for the day was debatable, with the St. John team in fuU slIrgical attire. It played Ollt to a two-all draw, with rule 'so mething' lik e occer. If wetne s was any indication of enjoyment, the game wa a huge lIcces. The dampe man on the field II a· the referee, Detective L Daniels, the local Crime Prevention Officer.

News from

the Divisions

CUMBERLAND - Mr. John Crellin, officer·incharge of the uniformed section of Working ton St. John I\mbulance since last June 24, commented at the annual meeting on the 37 year' service given by 1\ IL Willi,lIn Richardson, from whom he took over.

The merger of the association and brigade at local evel had been completed in 1972, and the committee was functioning well. lIe hoped it would add to St. John in Worki.ngton.

Mr Crellin said he was delighted to learn that Dr. Brian Robinson, the Divi,ional Surgeon, had been appointed a Serving Brother of the Order of St. John.

Divisional Kathlyn D Wilson and David Taylor. in their reports. thanked members for the duties they had done and hoped would continue the g00d work 111 1973, with a true team The lotal membership. lllcluding officers, was onl) 31 (15 men, 16 \\omen) and many more were needed to cover duties ctTieienLly.

The number of recorded hours of public duty in 1972 was neaflng 4.000. an 1l1cn::ase for the third year. ThiS involved a high standard of training at the 46 class night-;. in order thaI the members are efficient and able to cope with an) accident or illness. I\bout were recorded by members on and ott duty

NORTHANTS - The Cinals of the Ilrsl competition in orthamptonshirc Cor St John driver, and attendants took place at \Vellingborough during l ebruary Pceilmll1J.ry rounds had taken place at Northampton. \\ ellingborough and Kettering and the Corps \\cce in action against each other tor the premier award. the Drivers' and tlendunts' Shield. The contest centred on thl' \Vellingborough Lounty umbulan ce station, the laff of \\ hieh were responSible tor the patlenh and much of the arrangements. The

compc t itors werc tested for the ir driving, first aid and the hand ling and care of the patients. A nearby factory provided thc silC of two acc idents which had to be dealt with a thigh wound with arteria l haemorrhage and a case of e lectr ca l shock with a third man involved. Thc crews first made a tour of thc town to show their dnvi ng abili ty before being 'called' to the accident. The driving was assessed by Mr. M. R. Why man of the Northants County I l ealth Dept., a former member of the County Ambulance Staff; and the first-aid work was judged by Assistant County Ambulance Officer

Mr M. Tarry, Deputy County Ambulance Supt. Mr. R. W. Webb and Station Officer Mr. II. E. Desborough.

Mr. Tarry and Mr. 13. E Billlllgton, Deputy for orthamplomhlre, who presented lhe shield to thc winners, both voiced pleasure that the full timc servicc and St. John were working so well together.

The winners were Northampton Headquarters crew, Divisional Supt. D. Billlllgton and corps Staff Officl!r R H Shaw who gained 199 marks, Thrapston (Kettering Corps) second 190, and Rushden (Weilingborough Corps) third 161 Ambulance

Member M. Tebbutt of Thrapston \\ as Judged to be the best driver. His colleague was Ambulance

Member T. t.lmer and the R ushden crew was SergI. D. Porter and Ambulance A. Ilardy.

County Staff County Public organiser. The annually.

Ofricer J. W Chapman, Dutics Officer. was the competition is to be held

OBITUARY

IVOR CJ\LLARD, 70. DIVISIonal Officer (retired). Founder member, Fast 1\loor Steelworks Ambulance Division in 1927. Carried the Colour at the Royal Review, Hyde Park, in 1962. Over 44 years in Brigade.

LESLIt. CHARLES GOTCIl, died on ovember 26, Secretary 0 \Velli ngborough Corps for 15 years. 50 years in Brigade

(Photo

REVI EW CROSSWORD NO 4 ( 73 Compiled by W. A Potter

ACROSS

1. Anaemia of enmity? (3.5 ). 8. Be c ame ill ag a in a f ter improvement. (8). 9. Violent period for indige s tible p a rt of d et. (8). 11 Slough of gangrene or deep burn from broken a r c he s. (6), 12. Shows signs of advancing years. (4). 13. Stret c h o ne elf for a quantity of paper. (4). IS. Is sick a fter s tupid fellow a t ac k s violently. (7). 17. Part of heart and lung (4). 19 Pimpl es o ne ge ts when the skin is cold. (5). 20. Large gl a nd wilh many fun c ti o n s (5). 21. Principle organ of a cc omm o d a tion. ( 4). 23 Sep ara e from the community because of illne s (7 ) 2 6 End o f the freeze. (4). 28. Give birth to a Sto c k Exchange pess imi s l. (4 ).29. Even if not a dog, he is interested in bone s. ( 6). 30 Put t o g e the r ragged cut or type of muscle. (8) 3 2. Saint with broken n o e is following narrowing of anatomical opening. ( 8 ) 33 Orth o p ae di c procedure for correction of deformity. ( 8 ).

DOWN : 1. Rumblings from the abdomen ( 10) 2. Listening devi c e f o r blood-sucking; parasite. (3). 3. Earache (7). 4 App e ar s o b e a female doctor to tend a wound (5) 5 Quit e n a tur a lly oses consciousness. (6). 6. Pa c e s v a ried before list for co n s ultanl. (10).7. A minor matter for small military deta c hm e nt. ( 6 ), 10. Its formation is one of the function s of 20 a c ro ss (4) 14. Degre e of tension indicated by quality of sound fr o m c on tra c tile ti ss ue ? (6.4). IS. Article 10 on nerv e fibre (4). 16. Fruit f o r n aevu s. (10). 18. Face in faint or loss of blood. (4) 22. Deputise fo r a colleague on lhe duty rota. (5.2) 24 Be quiet a bout h e al covering tendons and muscles. (6). 25. Bird in fe cting mu co u s membrane of the mouth (6).27. Stop the lame.(4 ) 2 8 Cau e o f severe lung injuries in explosions. (5) 31. Central feature o f a c ut e laceration. (3).

SOLUTION TO CROSSWORD NO 3 (7 3 )

ACROSS :

1. Coldness; 5 Antrum; 9. Paragoric ; 11. Trail: 12 Eye-drop ; 13. L.act.ase; 14. Ca.rot.id 15. Ve.il; 19. Rare 20. Tottery ; 2 4. Phrenic; 25. Ex.creta ; 26. E.n.try;

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Apply to MISS M. B MacKellar, Matron.

MOORFIELDS EYE HOSPITAL CITY ROAD LONDON, E C (26)

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.A Anatomical Teaching Models

Around

First

Readers'

Severe

- Wales p.20

Overseas News - National FA Competition Results p.21

News from the Divisions p.22

EDITOR FRANK DRISCOLL, 26 Pembroke Gardens, London, W8 6HU. (01 6038512)

ADVERTISEMENTS Dennis W. Mayes Ltd 69 Fleet St London, EC4 (01-3534447 and 4412)

Pri ce 12p £1 70 per annum, including postage, from Review Sales, St John Ambulance, 1 Grosvenor Crescent, LondonSW1X 7EF

Cover :

During the coming months many members will be helping the handicapped to get away for a holiday, as seen here at Huddersfleld station when a party from the Cripples' Guild were leaVing for Blackpool. (Photo: Huddersfield Examiner)

AT RANDOM

by Watkin W. Williams Deputy

Commissioner-in-Chief

I AM WRITI G on the evening of the day when His Royal Highness Prin ce Richard of Gloucester (Commandant-in -Chief of Ambulance Corps and Divisions) , accompanie d by Prince ss Richard (Staff Officer to the Chief Commander), paid his first official visit to St. John Ambulance Headquarters. After meeting senior member of the Association and the Brigade branches for co ffee in the conference room, Their Roy al Highnesses spent more than an hour touring the building and talking to all members of the staff at every level and in every department. They then came to the St. John House Club where they met the Warden and Deputy Warden and staff and were the Guests of Honour at a luncheon party, and they honoured us by signing the visitors' book before leaving. For us - and, we hope, for them this was a particularly happy Royal Occasion, ince it combined an atmosphere of due formality with an element of informality that was inevitable when we were welcoming and entertaining those whom we were already privileged to regard as colleagues and friend For tllOugb it wa Prin ce Richard's first official visit to Grosvenor ere cent, it was by no means his first visit; and Princess Richard wa of cour e fully at home in a building where she has now been working for the pa t three months and where tomorrow evening she is due to attend a a candidate at the tart of an Initial Nur ing Cour e. I wi h I could adequately convey to you the extent to which our Royal Guest showed themselves to be personally involved in the activities of the Brigade, but 1 hope that the mere a urance of the reality of that involveme,nt will be an inspiration and encouragement to you all.

Pl anning

ow is the time (if you haven't tarted already) for your division, whether adult or cadet, to begin planning your next win ter's programme. By the time the summer holiday is over, the absolute 'musts' in your yearly programme will I hope be over too. I mean, of course, the divisional AGM (which should have taken place long before you read thi ). the annual re-exam and the divisional inspection. So you'll be all the more free to plan a progres ive programme of training for your members from, say. the beginning of October to the end of i\larch. Thi involves, fir t of all, an open discussion with all members at a Divi ion31 Meeting (ee econd para. of B. R. l25) at which suggestions for the winter programme can be put forward by all and sundry. These suggestions should then be referred to the Divi ional Committee (see B. R I '22) at which it is essential that the Divi iona1 Surgeon and ursing Officer should both be present, si nce they are re pon ible for training the divi ion in first aid and nursing techniques. Everyone present at this meeting hould have Cuntillued a ll page I J

Medical Conference '

With Nottingham SJA members, the RAF put on a display of their mobile air evac uation hospital, with a casualty being trans ferred fro m a tleld hospital (Ieh) to a helicopter (below)

was 'Transport, Trauma and Transition', which included a symposium on 'Aeromedical Evacuation' introduced by the Director-General, RAF \!1edical Services, Air Marshall Sir Ernest Sidey, and included a display by the RAF of their mobile air evacuation unit and field hospital.

The close liaison which exists between St. John Ambulance and the Armed Services becomes more apparent each year. At the 1972 conference the Army and the Navy demonstrated their cooperation in two extremely in teresting

THE 4TII St. John Ambulance Medical Conference, chaired by Professor ir Hedley Atkins, chairman of the SJA Medical Board, wa held at ottingham University during the weekend March 30 April L

300 people attended the conference (last year there were 220) including representatives from hospllals, univer ities and industry; from SJA in Canada, and the orwegian and the British Red Cros · ocieties; and SJ A members from all parts of the British Isles to listen to uch speakers as Sir Derrick Dunlop, Mr. II. Proctor of the Birmingham Accident Hospital, and Dr. \1ansonBahr of the Hospital for Tropic:1l Di ea e

The theme of this year's conference

Jerusalem

Memorial

In the Muristan, which is in the centre of the Old City of ] erusalem, the 0 rd er has erected a fine memorial to the work of the Kmghts of St. John in that cit y through the ages. The memorial sta nds 111 its own walled garden on the site of the first hospital of the Knights of St. John in Jerusalem, during the 12th and 13th centuries, and IS very close to tbc Church of the IIoly Sepulchre. It also coJ1lmemorates the establishing of an ophthalmic hospital in the city in 1882 by the Grand Priory of the British Realm. The present Ophthalmic Hospital's new building is about a mile from the site.

The memorial stone is in one piece and weighs some 14 tons. It was roughly shaped off the site and then brough t very carefully via the narrow streets of the Old City and completed on site.

A fine reminder of the Order's work in this city of religions.

sessions: 'The Three 'Rs' of Climate' and 'Hazards of Underwater Activities'. This year, with representatives from the two other Services in attendance, the Royal Air Force certainly strengthened their ties wi th the service of S t. John.

The obvious feeling of all who attended the 1973 conference particularly the 180 or so St. John Ambulance medical and lay members from some 38 St. John Counties was one of great satisfaction and comradeship. Many new friends were made, ideas exchanged, and information obtained.

BRIGADE SUMMER GET-TOGETHER

A number of vacancies are still available for the Brigade Training Covent ion/Holiday to b e held at the RAMC Depot Mytchett, near Aldershot, next August 6 to 18 As well as 2 hours training a day in first aid and allied subjects, there will be a very in teresting and exciting programme with displays and demonstrations at the headquarters of the Army Air Corps, including a demonstration by the Blue Eagles. There will also be visits to other service establishments and a number of excursions to places of interest and entertainment. Full sports facilities, including swimming baths, will be available.

early 100 mixed members of the German Brigade will be coming over for the fortnight as well as SJ parties from Canada and other countries. This SJ fortnight is for young adults of both sexes and the overall cost will be abouU 12 a head. Those interested in this international SJ get-together can get details from the County HQ. But book early.

(L) The memorial and (above)

Head Injuries

by R. A. Elson, MB, FRCS.

EVERY FIRST AIDER is aware of the dangers of the head injury which has been sufficiently severe to have caused unconsciousness. The care of the unconscious patient with regard to preserving the airway and respiration, followed by the safe transport to hospital, is usually well understood. Being 'knocked-out' is far from the romantic picture usually portrayed in cowboy films and boxing: on the contrary, it is a highly dangerous episode and probably always causes brain damage, which is permanent. In the majority of cases, the brain , which possesses such enormous powers of compensation is able to cover up for the damage but, of course, it is well known that repeated episodes of minor head injury lead to progressive damage and this has been the subject of much discussion on the question of boxing as a sport, amateur or professional.

It is the purpose of this article to explain why the course following a head injury is variable and sometimes so serious. The vast majority of cases recover quickly but it is the occasional exception, for which so much can be done surgically, which can be missed if our management is not competent. Competent management begins with the first aid, and reliable guide lines are set down in the manual. For the more enquiring, some explanation of the mechanism of the head injury may be satisfying and we are concerned here with the closed injury, i.e. nothing like a compound depressed skull fracture, but only a blunt blow to the head; this migh t occur in a car collision when a passenger, not wearing a seat belt, is flung forwards onto the windscreen, striking his head. The forward movement of his head is suddenly arrested; it is violently decelerated (to use the proper engineering term)

The Anatomy

The brain is rather like a blancmange in a box. In its deeper layers it is firmer due to the abundant closely packed nerve fibres (the white matter), but the outside (the grey matter) is very soft and fragile. This soft material contains numerous blo od vessels.

Think of a blancmange in a basin ; if you tap sharply on the outside the blancmange vibrates and you can see waves on the surface; the shaking so produced quickly subsides. If you increase the sharpness of the blows, there comes a time when the surface of the 4

blancmange will split. Exactly the same thing can happen to the brain, and if it sp lits this must cause the rupture of the thin walled blood vessels in the grey matter and consequent bleeding. The bleeding will cause further tearing of the brain material if it is forceful enough, as might be the case if a larger artery, at high pressure, is ruptured.

The soft brain is protected from undue movement and shocks, as experienced in everyday life, in two ways: firstly , it floats in fluid (the cerebro-spinal fluid) and this cushions the surface. Thus, if the brain is thrown towards the inside of the skull, as would happen in the case mentioned above, in which the head movement was arrested suddenly by the - windscreen whereas the brain inside sti ll tended to progress forwards, the cerebrospinal fluid which fills the in terval between the skull and the brain (several millimeters) has to move out of the way before the brain can strike the inner surface of the bone and, in so doing, it absorbs some of the energy of the blow.

Secondly , the inner surface of the skull is not just bare bone, but is lined by a tough membrane called the dura. At some sites the dura is thrown out into strong folds which fill certain of the large grooves and depressions which separate parts of the brain from each other. One of these is very large (the falx) and it divides the interior of the cranial cavity into two halves, whereas another horizontal fold forms a tent-like shelf between the cerebellum and the cerebrum (see diagrams I and 2). The bone of the skull also contributes to these infoldings and the brain is snugly supported in its fluid cushion and remarkably protected from injury.

The blood vessels in the surface grey matter which is so soft, have been mentioned. These drain into veins which have to cross the interval between the brain and the skull in order to rea ch some very much larger veins (called sinuses) which lodge in the dura Clearly, if the brain is flung forwards, these veins will be stretched and, in some cases, especially If weak, as in elderly people , they could rupture. Any bleeding inside the dura, as would occur from such damage to the veins crossing the space, is called subdural bleeding. Now the dura s bound to the inner surface of the skull but can nevertheless be str ipped off quite easily, and therefore between the sku ll and the dura there is a potential space and in it run

some arteries. These, because they are outside the dura, are called extra-dural and, if they were ruptured, as might occur if the kull were fractured, the consequent bleeding would be called extradural.

To summarise so far : the bleeding with which we are concerned in a head injury may be:

I. Within the brain where it may cause a bruise (haematoma) and swelling.

2. From the surface of the brain if the soft grey matter is ruptured, always associated with bruising and swelling.

3. From the subdural veins, leading to a subdural haematoma.

4. From the extra-dural art erie , causing an extra-dural haematoma. lf the dura ruptures, this haematoma will escape into the subdural space and become a ubdural haematoma.

All of these can exist together.

The Brain's Response to Injury o-one fully understands the brain function. It i a remarkable organ, much of which does not appear to be used. Certain key areas are more understood however, and in particular, the brain stem which connects the cerebrum and cerebellum to the spinal cord is of great importance it contains vital centres controlling respiration and heart function_ If its work i impeded, death is inevitable. The brain response to injury varies according to the nature of the di turbance bu t, basically, the latler of two types:

(a) Mechal1ical shock the brain is flung forward or rotated violently, a might occur in the car collision above, or following a blow on the side of the jaw. De pite the cushioning of the cerebro-spinal fluid, it hits the inner surface of the skull (or, to be more precise, the dura which lines the skull) and a shock wave passes through the substa n ce of the brain, just like the blancmange. This has the same effect as an electric shock, and in some illunderstood way, causes a temporary of consciousness. There may be some very small haemorrhages from torn capillaries, but no l arge ve sel bleeding. As has been stated already, repeated episodes like this can produce many more of these little haemorrhages with 8 permanent effect but the usual picture is the loss of consciousness, which is very sudden, followed by a rapid regaining of consciousness within ten seco nd s or so.

Following regaining consciousness, the patient feels trange: he may act unu slHllly, be drowsy, have slurred speech, not know where he is or, o n occasion, be frightened and violent. Occasionally, however, he may say he feels perfectly all right and wants to go home. Over the next few days, most of these symptoms subside but, in some cases, he may seem more lrritable than usual, but unable to concentrate or sleep well and often ha s variab l e headache ; these mild but troublesome features can last several months but usually clear up eventually.

ThiS IS the c lini ca story of what is known as conclission. The important feature s are sudden loss of consciousness for seconds, followed by rapid regaining of consciousness and troublesome post-concussional symptoms. There is always a loss of memory for the events immediately preceding the injury. The patient later may say, for example, 1 remember the car coming at me and then being in the ambulance on the way to hospital' he does not remember the impact. The more severe the injury, the longer is the period of lo<;s of memory (amnesia).

(b) Bruill bruisll1g or laceration this will always be accompanied by the conCliSSlon events described under 'mechanical shock' because the latter mu t have occurred to have produced the bruismg or laceratlOn. Recovery with regaining of co n ciousne will, however, be slower and if any vital ce ntres have been damaged, there may be some permanent los of function, e.g. a weaknes s of some part of the body. Also, a laceration will leave a car and this can act as a source of brall1 irntation and cause fits, later in lifc. The delay in regainll1g conSCloune can be aggravated by brain compression due to swelling or bleeding.

(c) Bralll cUII7/JreSSiOIl the skull is a closed box and if the brain swells due to bleeding or oedema, the pre 5ure inside must rise. This makes it more difficult for a rteri al blood to get into the box and

Dural folds

I. Falx l:rent

sea sku y

therefore the blood pressure outside tends to rise in order to force blood in. Further, the veins draining blood from the brain can be compressed and therefore blood finds it progressively more difficult to escape from the brain and skull; the brain s wells even more and, as a result, a vicious circle is established. The brain is very soft and the raised pressure tries to squeeze it out of the skull like toothpaste; it tends to herniate through the large hole s in the base of the skull (leading to the spinal canal) and through another hole bounded by the tent-like infolding of the dura mentioned above, whicheparates the cerebrum from the cerebellum. As the brain displaces, the brain stern becomes compressed or nipped and, if the vital cen tres are paralysed, death supervenes inevitably unless the compression ca n be relieved in some way as a matter of urgency. Also, nerves leaving the brain, especially those con trolling the eye movemen ts may become stretched, and this is the reason for the importance of observing the pupil. The raised brain pre ure is reflected in changes inside the eye-balls and you will see the surgeon looking through the pupil in order to see if the retina hows signs of swelling.

Brain compression can be caused by the swelling of the brain itself, or by the development of haematoma (blood clot) in the subdural s pace or m the extra-dural space. Sometime, and this is more common, both conditions occur.

The Events Following a Blow to the Head

The mechanical shock may have been severe enough to have caused the

Concussion Syndrome (for a definition of the word Syndrome, see last month's article on Calf Compression Syndrume). There is a quick recovery and eventually no residual trouble. The first alder will have had the best opportunity to have observed any period of unconsciousness which, subsequently, the patient may not remem ber. Also, the first aider will be able to obServe and document the recovery and mental state following such unconsciousness.

If the unconscious state is prolonged, this is immediate evidence that more than simple mechanical shock has affected the brain. There may be contusion or laceration. On top of these, the effects of brain compression from haemorrhage may be added, but the latter takes time to develop depending on how rapidly the bleeding is occurring.

Sometimes, treacherous times, the unconsciousness from mechanical shock, leading to the Concussion Syndrome and a quick recovery, may be succeeded by a period of relative normality during which the patient may speak sensibly and profess to feel perfectly well. Soon, however, due to the effects of brain compression from bleeding, he lapses slowly into loss of consciousness. The intervening period, when he appeared to be recovering well, is sometimes called the lucid interval. As will be explained later, it can last hours, days or months, and it is conceivable that the first aider could be involved with the head injury patient at any of these stages.

In the continuation of this article next month, we will try to explain how this variable pattern comes about.

The Medical Aspects of Driving a Car

by VVendy A. Robinson, SRN

DRIVING A CAR IS OF VITAL INTEREST TO SJA MEMBERS,

FOR NEARLY 18 MILLION PEOPLE IN THE UK HOLD DRIVING LICENCES. SOME OF THEM, TOGETHER WITH THEIR PASSENGERS, ARE POTENTIAL CASUAL TI ES

NEARLY HALF of the male d eaths which take place in countries where the motor car is a common form of transport occur among drivers in the. 15 to 24 age group (in New Zealand you can hold a licence at the age of 15) This was disclosed by Dr. John D. J. Havard , Under Secretary of the British Medical Association, at a meeting held in London under the auspices of the Royal Society of Health, to discuss 'The Medical Aspects of Motor Vehicle Driving'.

These figures, said Dr. Havard, had been almost unnoticed by the public. But if such a large proportion of deaths in this particular age group had been caused by tuberculosis poliomyelitis, cholera or some other condition traditionally associated with public health, it would have been regarded as a national scandal. Yet this group was one in which eyesight and reaction time were at their best.

Nearly all these deaths are of drivers of motor vehicles. R elati vely few pedestrians are kilJed in this age group.

O n the other hand, said Dr. Havard the age groups in which accidents were least likely to happen were those already subject to the degenerative process of a g eing. The explanation for this was probably because many drivers with pathological or physiological handicaps adjusted their driving performance accord ingly.

Seat Belts are Vital

It was those who earned their living from driving who were more at risk from medical conditions. This was because they were at the wheel for exceptionally long hours, Dr. Havard stressed. As a result, they were particularly likely to be involved in accidents causing injury to other road users, if the driver collapsed or suffered from any loss of function which affected his driving.

D r. Havard revealed that as a resul t of accidents, the loss of expectation of life in Britain for men, was about one year compared with one month only for all 6

infectious diseases In his opinion this made the case for the compulsory wearing of seat belts an urgently necessary piece of public health legislation. In the same way, the provision of crash barriers , however aesthetically undesirable, must be regarded as a priority.

Drugs and Dr iving

The vexed question of driving and drug taking was discussed at length by Dr. Havard. He said that it might be expected that drug usage would be a major cause of road accidents but there is very little evidence available , so far, to support this - in spite of the fact that in 1967, abou.t 20 million prescriptions for sedatives 14 million for tranq uillizers , five million for antihistamines and five millipn for antidepressants were dispensed under the NHS.

'C e r tainly, tranq uillizers and depressant drug (unless they combine euphoric properties like alcohol) might be expected to counteract any tendency in drivers to take unreasona1?le risks ,' said Dr. Havard, 'and it is possible they may drive more carefully and within the limit s ,of any reduction in perception induced by the particular drug concerned.' Such evidence as is available suggests that it -is the stimulant drugs he added, which significantly are most likely to increase the risk of acciden 1.

Combinations of drugs with other drugs and in particular with ethyl alcohol must be avoided, Dr. Havard continued, and patients must be advised to stop driving as soon as they felt unwell or affected adversely by the drug One problem he suggested might arise, with the increase in cross Channel car ferdes, was that drivers might take antihistamines to alleviate sea sickness and then drive off the boat before the effects of the drug ha d worn 0 ff.

Dr. Havard warned that it was a matter of some concern that the effects of new drugs on driving ability are not tested as a

prerequisite to marketing in this country.

If the effects were not known it was impossible for doctors to issue the necessary warnings to their patients.

Drinking and D riving

The dangers of dnnking and driving were emphasised by Dr. IIavard. 'Alcohol,' he said, 'is probably the most powerful depressant of the central nervous system to be available without the need for a doctor's prescription, Jnd when these properties are combined with a skill as complex as driving, and the taking of alcohol is accepted as a socially desirable habit in the community, it is hardly surprising that a problem anses.'

Wherea s many people with medical conditions recognised their impairment, alcohol with its euphoric properties caused drivers to overestimate their performance, very often WIth disastrous results.

The oml ion of a single medically qualified member on the Board of Direction of the Road Re earch Laboratory - which controls road research i n Britain was criticised by Dr. Havard

The result of this, he said, was that the chance of resources being channelled into an epidemiological study were small. A great deal of research was required to be carried out before they could ascertain what aspects of driver behaviour increased the risk of accident involvement. Su c h work, he urged, must be undertaken using epidemiological techniques and should include carefu l as essment of the influence of environmental factors on this type of behaviour.

Apa h y o R o a d Saf et y

Surgeon Rear Admiral Stanley Miles, Dean, Postgraduate Medical Studies at Manchester University, said that there seemed to be an apathy to road safety. When the odds against being killed on the roads during anyone year are about 6,000 to one, there would seem to be little to worry about. But this represented a great deal in economic loss and human suffering, he added.

A happy - and be lted passenger

Protect yourself by using a seat belt but remember, too , that the passenger's life is in your hands The photograph shows the Britax -Star Rider' children's safety seat with a special buckle that holds all the sections of adj ustable webbing together firmly It can be fastened or released with ease by the parent. The foam cush ioned seat has snap -cl ip fasteners to allow it to be speedily installed or removed from the car

'A motorway "pile up " killing 20 people will cause national concern,' he said. 'Such pile ups fortunately are rare but 20 people die ji-om injury e ver), lilli e hours. These mostly are isolated events causing little ge neral interest. To the friends and relations it matters little whether the breadwinner is k.dled in a dramatic multi-vehicle shambles or is discreetly elimina ted by a careless driver.

A national organisation was reqUired, said Rear Admiral Miles, which could give the best .e rvice to anyone who, in any circ um stances, might be injured or suddenly taken ill. But they would stili have to rely on the public in both alerting the emergency services and rendering effective, on the spot first aiel In this

connection the public hould be in tructed in modern technique s of reSUSCitation which could be Jcqui red :Jfter a few hour' tuition

However good the first aiel, however gooel the emergency services, the fact remained that an injury was a ign of Ltilure, omething 'which should have been avoided. The study of man under special stress has contributed much to the understanding of survival and avoidance of injury, according to Rear Admiral Mile. The hazards of a journey to the moon, sUlgle-handed round-the-world sailing, trans-ocean rowing, living on the ea-bed and many other dramatic achievements are possible, WIthout inJury. Why not, therefore , he questioned, the everyday

Journeying on the relatively safe stretches of road and motorway?

l uch ha been done in the past by epidemiological research to eliminate many deva tating di eases. What i needed today, aid Rear Admiral liles, is a major all out attack on the problem of injury by mean of epidemiological tudy and enlightened practice

If the public at large seemed apathetic, there wa no apathy among the audience. Recently at llnother meeting, the chairmlln said that he judged the ucces of a t)6 ion by the number of que lions from the floor. By this yardsti 'k it was indeed a very successful meeting.

( Re/J/'inted ./"0 111 \'llrsil1g Times)

ORDER CHANGES

Mr. David Swinstead has resigned as Treasurer and Accountant of th e Order of St. John from the end of April after nearly 20 years of devoted service.

Mr. W. P. Leach, Assistant at the Chancery of the Order since 1965 has been appointed Superintending

Mr. Linge has been appointed Security Co-ordinator at the Palace of Westminster, so he is leaving his employment with the Order.

AT NO . 10

1 hear that two Brigade members , Headquarters' Staff Officer Capt. D. J. Lafferty, MBE, and Deputy Commissioner, Commandery of Ard s, Col. J. Hughes, OBE, were among the guests invited by the Prime Minister to a reception at 10 Downing Street recently in honour of War Pensioners and ExService Organisations

Capt. Lafferty is the General Secretary of the Royal Alfred Merchant Seamen s Society, which administers the National War Fund for Merchant Seamen, and Col. Hughes is the present Chairman of the Royal British Legion.

The Prime Minister talked to Col. Hughes and Capt. Lafferty about their respective organisations (and subsequently thanked all present for the charitable work they carry out) and the war pensioners for the suffering they had endured in the service of their country.

The reception was overshadowed by the bomb outrages in the city that afternoon, and necessitated Mr. Heath leaving early to visit the casualties in hospital.

On duty at the Prime Minister's official residence for the reception were Brigade members of London District who assisted the severely war disabled.

WINNERS

IN GE R M AN Y

AROUND and ABOUT

WHAT'S GOING ON I N THE WORLD OF ST. JOHN

SE LF SERVICE [ hear that former Roy al Docks rigger Mr. Terry McSweeney is very glad that he went on a ational Do ck Labour Board first ai d traini.ng course - it saved his own life after suffering serious injuries in an accident at work.

M r. McSweeney was hurt while working as a crane driver in Surrey Docks.

In a letter to the London Dock Labour Board he said: 'Takin g this course enabled me to attend to myself. The doctor told my wife my actions helped save my life.

'I had a steel plate piercing my chest, fracturing my ribs. [ had stabbing wounds in the chest and back.

'I pla ce d myself in a coma position covering the front wound with my hand: he went on. 'The wound in my back was sucking in air owing to the fact that my lung had stopped working.

'While waiting for an ambulance I explained the principle of the kiss of life should my other lung stop working.'

Mr. McSweeney, who is now on the way to recovery and doing an office job, added: 'I am very glad [ went on this first aid course and would advise anyone else to do the same.'

The

APPOINTMENTS

Committees: Miss Romilly, Asst. Supt-in-Chief will be succeeding Mrs. Boothman as the Order's repre entative on Age oncern.

Fiji:M r. W. P. Ragg retired as Dep. Commissioner.

Sri Lanka: Col. F. 1. G. Caspersz, to be Secretary St. J. A. Council. Vice C. l. Edwards.

St. Lucia: Lt Col. E. M. V. James, OBE, KPM , to be Chairman of Council. This appointment has been notified previously but does not seem to be generally known.

Surrey: Mrs Tremlett to Asst. Supt. (N).

THE REAL THING

o. 69 Lewisham Tursing Division member Miss Doreen Cooper, who regularly helps on the wards at Lewisham Ho spital, had to put her emergency resuscitation training into practice while on ward duty recently.

A patient who had been unconsciou stopped breathing. Miss Cooper put through the emergency crash call and then helped the nurse on duty to put the patient on hi back while the trained nurse gave cardiac massage and our member applied mouth-to-mouth resuscitation.

Do ctors worked to keep the patient alive, while another patient in the ward, a former Brigade officer, gave moral support. Miss Cooper was allowed to accompany the patient to the intensive care unit. He lived for 10 days.

It is sad to learn that the patient died, as also did the former Brigade officer at a later date.

But this incident shows that St. John services in the hospital ward can be of great assistance, and our training prepares members to help house-bound patients after discharge from hospital - and the aged.

STUDY DAY

SJA members, North Devon Area attending their fourth annual study day, held at Barnstaple, were delighted to welcome the Deputy Commissioner-inChief, Major General D. S. Gordon, who

BY THE EDITOR

was visiting Brigade Units in Devon and Cornwall.

The study day organised by Area Surgeon , Dr. Alan J. Riley, and introduced by the Area Commissioner, Dr. E D. Lindsay, included lectures and films on Injuries to the Eyes, Symposium of Drug Mi use, the Hazards of Underwater Activities LInd A Journey through the Stomach.

AddreSSing members the Deputy Commissloner-in-Chief. who was accompani e d by the County Commissioner, Mayor T. W. Gracey, spoke of whid1 was due to local government changes ThiS, he said , wa'; bound to a ffect certain Counties. Nobody liked changes. more particularly If they are affected In principle it has been agreed tha t we must conform With local government. The Dep'.Jty Commiss i oner-in-Chief s aid that his thoughts were mainly to the future and these were very much directed to the younger members of the Brigade lIe felt that the training that is offered to these members hould be exciting, enterprising and instructive one mLl t think beyond purely basic first aid training. He then dealt wlth the que tion of leadershlp at every level. He felt that the key man , the Divisional Superintendent, mu t have an inherent quality of leadership 111 him. changes had taken plJce over the year. and we mu t be efficient in every aspect and continually looking at equipment and techniques, to be geared to face unforeseen and unexpected events.

WELFARE

If I can help omebody' sang the soloi t at the silver jubilee of Southampton's Friends of St. John Welfare Service recently.

Singer Margaret Sand ells L'er t ainly echoed the philosophy of li ss F. M. Tutte, MBE, who tarted the ervice 25 years ago and attended the celebrations stili as leader despite health problems.

As a Corps Superintendent ( ursing) in 1948, Miss Tutte felt it was time something was done for the old and lonely who pent their days at home or in h ospital.

The trolley hop service, now an accepted sight in most hospitals, was her idea, and with the formation of the wel-

S uperi ntendent inChief Lady Moyra Browne visiting ser· vice hospitals in G er many recently

fare ervice her influence grew. Today the ervice has 175 members who regularly visit 400 old and lonely folk.

Mis s Tulle's latest idea is to start a junior section , and more than 50 Scholing School pupils visit Southampton's old people in their homes.

The Central Baptist Church, Southampton, was full for the Sliver jubilee service, which was followed by a reception when guests were welcomed by Lady Margaret Power , president of the Friends of St. John Welfare Service.

Marjorie, Countes of Brecknock, Chief Presiden t, cut the silver jubilee cake.

liss Tutte, of 4 Archers Rd. Southampton, would be pleased to send further information to anyone wishing to start a similar service.

ANDY

Andy, or Mis Amelia Anderson, the SJA nur ing member who has watched over hundreds of audiences at London's Royal

TRAINING

130 ambulance and nursing members from Norfolk at tended a training weekend during March (Seated) County CommisSioner, Brig. F. P. Barclay and County Superintendent Mrs D. L Lloyd Owen; (standing left) Brig A. Miller. Chief Sec retary who spoke on St. John in the 70s', and Lt. Col. H Blount, Deputy County Commiss ioner, who spoke on 'Water Safety' Photo Eastern

Albert Hall for nearly 30 years, has, I hear, retired.

Miss Anderson, who is still a Dani.,h citizen, came to Britain just before the First World War 'to learn English'. She was allowed to jo in the Brigade Reserve during the crisis of 1938.

When war broke out she was among the personnel at a First Aid Post in Gledhow Gardens, Kensington, where the militant ladies of Kensington were so keen to defend the borough against the threatened German invasion that they got a scolding from headquarters.

Unbeknown to the authorities, they enlisted the help of a sergeant at Chelsea barracks to teach them not only how to fire pistols and rifles but how to toss hand grenades!

'We used to practise creeping round the bushes in the garden.'

When headquarters heard about it they very swiftly sent a reminder that am b ulance workers were non-com ba ta n ts and the shooting had to stop.

Although there were obviously many

Daily Press)

time s of great stress and s train [t is only the amusing anecdotes that Andy recalls now, such as the time when m anning the Ameri ca n First Aid Post at the Milestone Hotel they were called upon to trea t a serviceman who had a bad c ut on his hottom.

When he was all neatly b an daged up he arose, only to utter another cry of agony. The broken bottle in his h i p pocket which had caused the first cut, had cut him again.

It was not until 1942 that Mi ss Anderson, who had served the No. 9 Kensington Nursing Division of the St. John Ambulance Brigade for so long as an un-uniformed and unoffi cia l m e mb e r was enrolled officially. It w as t h ro ugh t he action of the late Lady Loui s Mountbatten, who was Sup e rintendent- in - Chi ef, but knew 'Andy' through working alongside her in First Aid Po sts.

When the war ended s he continued her nursing service mainly at the Roy al Albert Hail where sh e worked an ave r a ge

of two days a week. She sat through thousands of concerts, conferences and en terta inmen ts.

Andy will be remembered by many

COMBINED

On Sund ay March 18 a simp l e but impressive Servi ce of Dedication was held at the Salvation Army Citadel in Dor chester, Do rset, for Edward W G. Cuff, who was made a Commander (Brother) of the Order of St. John last February

This was a combined Salvation Army an d St. Jo hn Ambulan ce service as 1r. C u ff has been connected with the Salvation Army for 60 years, as bandsman, Sunday School superi ntendent and treasurer, and with St. J ohn Ambulance for 52 year, being a founder member of the Dorcheste r Ambulance Divi sion, and of the Brigade in Dorset. He is now a county staff officer.

Many m embers and former members from both organisations attended the service Div/S up John E Hesketh, S o uthport Corps, and D O M iss W M R imme r also of Southport, were married recently

RELIEF WORK

I heur that an ex-A nd over cadet, 23-yearold nurse Margaret Morg<ln of Wherwell, left for Bangladesh during April to do relief work. She and 5 other nurses have gone to this troubled country of 75 million people under the ullspices of the B ible and Medical Missionary Fellow'ihip. It is reported that there are only 690 trained nurses 111 Bangladesh. largar et trained at Middlesex Hospital, and qualified in midWifery at Bri tol.

FELLOWSHIPS

In addition to the WInners of Churchill Travelling Fellowships mentioned in AT RA DOM (March) we have since learned that Mrs. E. Unelt (Areu Supt ( ) Worcs. Area) has been awurded u fellowhip to visit the Caribbean for three months to study the background of West Indian immigrants to Bntall1. Congratulations, 1 rs. Unet t!

The late County Secretary of Kent Mr. Burge ss being invested Officer Brother by Lord Monkton early this year. Photo: The Kent Mes senger)

GORDON JAMES BURGESS

Gordon James Burgess , County Secretary of Kent, died on l-'ebruary 23, 197 3.

After Ll distinguished war record (Mentioned in Despatches) in the Army. he was in Government service in East Africa (doing much first aid training for Africunsl until 1962, and rejoined the Bngac.le before returning to the UK.

ll e was appointed County Secretary of Kent in 1966, a job he was to do accurate l y, whole-hearted l y and, of great importance in a voluntary orgunisation, tactfully.

r n 1971 he married, as his second wife, Christine Carole, and their great happiness was so tragically short-lived.

At the beginning of 1972 he had an operation which improved his health considerably until the autumn, when increasing pain made it more difficult for

I AT RANDOM (conlinuedfrompagel)

<I week-by-week diury of the winter months before them. Special even h, snch as a film or a Ll combll1ed evening with your neighbouring division (whether ambulance or nursing , adult or (Jdet), a social occasion in the Christmas season. and so forth, perhaps be filled in first. And you'll certainly want to leave at least one week. blank for the Christmas holHlLJys. \\ hen you've done this, there may be less than weeks left to fill in twenty weeks of well-planned constructive and inspIring training. Your first thought will probably be that it's about timc you ran another first aid (or maybe nursing) course for the public a very useful thing to do from time to time. But do /}leuS(' think twice before you deCIde to do thIS on your normJI weekly diVisional training evening. There is so much for us all to Iedrn, sO much that we need to do to improve the basic st.lndanj of our first aid and nursing skills. ls it right, or fair. that yt'Jr after year our members should be tied down to spendll1g ten weeks (approximately half) of their most valuable training period In the year in gOll1g oycr again and again the baSIC course of elementary trainl11g that they underwent to qualify for member,hIp'! rhey should he getling on to something more advanced than this, something that will give them a sense of challenge and inspir.ltion and advenlure; and if we don'l give them thiS, we can hardl) hlame them If they get a bIt browned off and their attendance drops perhap'> even to the point of their failing to attain annual 'efficiency'.

The Brigade-span ored Association cour e for the public is a very Jlnportilnt Item 1I1 llIvi,lOnal activities; but unle s your is either a very small or a very new diVision, IJle([se don't bore your members and block your chances of progressi\e trainll1g by always running it on your weekly divisional training evenll1g. For further suggestions nbout these courses, get a copy of 'Tllf' Class SecretarIes' Ilandb ook' (If you haven't got one already) Jel'eral mOl/fils before the course is due to start. and follow the udvice th,lt it give'> of the be'>t ways of gettll1g cuch individuul member actively IIlvolved in practical training is to work in mall groups of not more than eight. \ dl\ ISlon (whether adull or (.ldet) with an attendance of 24 members can run 3 or -+ such groups simuitaneollsly, Jnd swap over e\ery 15 or 20 minutes in the course of an hour's trallling. I he \ubJecls will depend on your indiVidual needs, but here are Just a few sugge'ltions in case yOll haven't tried (hem out lately: li fting a caualty in the recovery POSItion onto a stretcher: treatment of a cawalty with two inlurle'< oral resuscitdtlon of a casualty (Resusci-Anne) trapped in 1I{e driving scat of ,1 car: blindfold bundaging; treuting a casu,ilty out of doors after durk; stretcher-carrying over obstacles: aCCIdents in the home; assessment of priority of treatment of several casualties; giving liquids to a recumbent patient in bed; applying a kaolin pOUltice: giving an inhalution; moving a bedridden patient from upstairs to downstairs. Of course Yotl cun think of lots more, but the really importanlthing is that nothing sho uld be !cIt to the thM can actually be carried out

R ecently I heard an instructor lrying to describe how to apply a kaolin poultice; inevitably the class wa' completely befogged.

him to ca rryon working. But he did carry on, domg much of his St. Jo hn work at home.

Early this year he was promoted Officer Brother of the Order, but being unfit to travel to L ondon for the investiture Lord Monkton made the presentation at Maidstone. Soon afterwards, Mr. Burgess had to go back into hospital, still conti nuing his S J work from there. He died three weeks afte r becoming an Officer Brother.

The only way to learn how to apply a kaolin poultice is by opplvillg it. I'm driven almost to despan when, in a practice first aiders come up and say 'This is a bucket of water' and I ask '\\rhere's the water?' or 'This is a disinfectant solution' and 1 ask 'What disinfectant did you put in, and how much?' a'nd they reply 'Oh, there isn't any, really '. One last thought. During your winter programme you'll be getting some new members; and if you're an adult division, I hope that quite a lot of them will be recently promoted ca dets. Do please try to see that they find in your division what they hoped to find, and that having found it. they enjoy it. And if your hair is as grey as mine, L ju t can't tell you how quickly that experience will take ten years off your age'

Fun, it should be

I was told the other day of a county superintendent who sai d 'If enr St. John ceases to be fun, I shall clear out.' That's not selfishness; it's just realistic common sense. The whole atmosphere of St. John should be an atmosphere of jO)'. and one of a divisional superintendent's most important duties is to see that his or her members really enio,v all that they do; and if ever our work becomes a grim duty, it's a sure sign that something has gone wrong somewhere. What did our new young members hope to find when they joined our ranks? Surely it was a sense of friendly companionship and personal involvement in what R. L. Stevenson called 'the spirit of glad acrifice' and 'the infection of a good courage'. And it's up to us to see that they find it.

I often think of the tory told by Father George Potter of Pe ckham, of the Cockney boy who wa going round collecting beer bottles for n jumb le sale. Having knocked at one door which was opened by a pinched-look.ing woman of uncertain age, he brightly asked 'Got any old beer bottles, mum':" She drew herself up to her full height and said 'Do I look a if I should have any old beer bottles')' He gazed earnestly up into her face and then, with a dawning smile, said 'Got any old vinegar bottles, mum')' M3) heuven pre e rve all of u in St. John from ever looking as if we hoarded old vinegar bottle

An ill wind

!\[y attention has been drawn to the fact that the photograph on p.6 of the Rel'iell' was incorrectly cuptioned, for which the Editor JSk. me to expre s hi apologies. The 'na ty accident' wa in fad taged in a bu y hopping treet of Windsor, not Reading, and the divisions jointly re ponsible for taging it were the Royal Windsor Ambulance Division (Berks) and the Eton Combined Division (Bu(k ). But it's an ill wind that blow nobody any good, for this mi take provides me with an opportunity of cOlllmending the initiative of two divisions which are at present in two different cOllntie but will be in the ame county (Berks) when (he boundary changes ha\e taken place in a year's time, in gettmg to know each other and working together in t. J ohn activities well ahead of the time when one of them will be called upon to change its county allegiance. I hope that many placed divisions Jre doing likewise, and that if they are not. they will be encouraged to follow this plendid example.

Mr. and Mrs Cuff and Maj. Gen R J Moberley Commissioner Dorset, after the service (s ee COMBINED)

SJA Watford and Bushey Div SuPt. George Forbes

telephone from the chai rman of Bushey and Oxhey Round Table, Mr. Brian Park in. ( Ph oto: Watford Observer)

Eileen daughter of Div / Supt E Rooke

181 Dulwich Division and n iec e o f

First Aid -1911 Style

LOOKING BACK MAKES ONE REALISE HOW ESSENTIAL

ARE CONSTANT IMPROVEMENTS IN TECHNIQUES

by Alan Sharkey

CAN YOU imagine five people carrying out artificial respiration at the same time on the same c a sualty? Looking t hrough an early copy of 'First Aid To The Injured' I noti c ed that a situation was once envisaged.

The 1972 First Aid Manual has now made its impact Having read it most of us will realise that five y ears is not too short a space of time for improvements to be made in first aid technique s, even though there might have been a few grumbles a t f ir st. My copy of 'Fir s Aid to The Injured' printed in 1911, was the seventeenth edition of that book to appear over the s pace of just over thirty years. First aid always was and probably always will be subject to improvements and changes for the better, qui t e apart from the improvements in presentation made apparent by the 1972 manu al.

The most far reaching change s in first aid during thi s c entury have certainly been in the field of artificial respiration. Although mouth-to-mouth resus cit a tion was not unheard of at the turn of the century it was not a remedy that was referred to in the fir s aid text book. One method that was recommended was that of Dr. Silvester combined with Howard's method. Why not try it for your sel f one evening at a Divisional meeting ? Rearranging the original text so as to make it clear which duties would be p e rformed by each member of the team , the method would be something like this :

No.1 Without waiting a moment pla ce the patient on his back on a flat surface , inclined if possible from the feet upwards. Remove all tight clothing from about the neck and che st, and bare the front of the body as far as the pi t o f the stomach ; unfasten the brace s and the top button of trousers in men , and the corsets in women. Raise and support the shoulders on a small, firm cushion or folded article of dress placed under the shoulder-blades. Cleanse the lips and nostrils; open and wipe the mouth Kneel at a convenient distance behind the patient's head, and, grasping his forearms just below the elbow, draw the arms

re spir -

upwards outwards and toward s you with a swe e ping movement m a king th e elbows t o uch the ground. Bring th e patient s flexed arms slowly f o rward downward s and inward s, and pre ss th e arms and elbow s firmly on th e c h est on eith e r side of the breast-bone . Repe a the se movements alternately , d e lib e rat e ly and perseveringly about fifteen im es a minute.

No 2. When No I has placed th e p a ti e nt in position , draw forward the p ati e nt s tongue as far as possible and keep it in that position throughout the whol e tim e.

o. 3. K neel astride the patient's hips with t he ba lls of the thumbs restin g on either Side of the pit of the stomach, and the fingers grasping the adjacent parts of the chest. U. e your knees as a pivot and press forward on your hands. T he n sllddenly, with a final push, sp ri ng back and remain erect on you k n ees and s low l y cou n t to three. T h ese m otio n s are to be repeated to correspo n d with those being performed by No.1, pressu re on the chest being simu l taneous with o. I.

o. 4. Whilst artificia l re piratio n being applied, other usef ul steps may be employed su ch as by N O. 4 wh o shou ld apply smelli ng sa l ts or n uff t o the nostr il s to CXCI te respi ra t ion.

NO.5. For the same reasons as No.4, and

Ca rr yin g a pa t ient by the o e a n d aft me h o d a t the same tim e, o. 5 shou ld flick the chest with a damp towe l. Perhaps it is unfair t o suppose that F ir st Aid To T he Injured' w as inte n ded to be r ead so lite r a ly. Com m on sense m u s t al ways be the over-ri d ing considera ti o n in fi rs t aid and h is was no d oub so in 19 1 1 even tho ugh the poin t was not stresse d so empha ically h en as i t is now.

In many ways the 1911 text b ook r esemb les it 1972 successor. The g ene ra l l ayout of the chapters is si m ilar a l thou gh the conte n t is at t imes very d iffe r ent.

Th e r e is a comp ete page d escr ibi n g the action to be take n 'w h en a woman's d r ess ca t ches f ir e' An othe r p ag e a d vises wh at to d o in cases of hys t e ri ca f i ts. We a r e t ol d that h e patie n t, usua ll y a yo ung g irl, ub ides on a couch or so m e comfo r tab le

wi h cold wate r. A mustar d leaf at t

back of the neck is said to be efficacious. T h e illus t rations of unifo rm e d St. Jo h n m embers m ust be nos alg ic fo r those who stil l r em e m be r some t hin g of the ea rl y days. Th e r e is an il lu s tr atio n in the p r ice list of equi pm e n t a t t h e e nd o f th e book, of an a m bulance ca rri a ge of w h ich a number of improved d esigns are state d t o have been r ecent ly pe r fec e d severa l specimens of w h ic h ca n u su all y be seen at S t. J ohn's Gate, inclu d in g a lig ht vehicle to b e d raw n b y two m en or a pony costing £3 2-10- 0 Th e pric e lis t also gIyeS details of th e unifo rm t o b e wo rn b y 'cyc li s t s-s u p e ri n tendent' and 'c y cl is t sr a n k a nd file' Pe r ha p s one d ay the 1972 m a nu al w il l seem as stran ge to o ur childre n and grandchildren !

Artifici a

ation by Svester and Howard methods

Callis Melitei

OR TO MOST OF US - MAL TESE DOGS: OTHERS KNOW THEM AS ' THE JEWELS OF WOMEN'

by M . Iv eria

THE DROP-EARED white Maltese clog with its tea-pot-handle shaped tail, seen with Grand Masters of the Most Venerable Order of St. John m many paintings, has through the acquired a mystical significance. At first, no doubt, it was thought to be a charm against the evil eye then, perhaps, being a costly dog, a symhol of good fortune and, ultimately, it established a claim to posses the power of healing.

The dog figured prominently in the Hellel1Ic and Roman periods and was accepted for a time as native to Mediterranean lands, but its place of origIn is still obscure.

(Opposite) A Maltese dog at the feet of the G ra nd Master Pierre d'Abusson after the siege of Rhodes In 1480, when the Knights of St. John repelled a sea -borne Turkish force of 70,000 men To commemorate the victory, the Order's Vice Chancellor William Caoursln presented an eye -witness account of the siege in book form to the Grand Master In the Great Hall at Rhodes.

The book shown in the painting is now at St John s Gate

Excavations in Asia over the years reveal its existence there long before Western civilisation came into being.

Fragments of stone carvings representing the dog were unearthed in the Gobi Desert and in Asia Minor

In the days of Nineveh and Babylon it was held to be 'salutary against gout and stomach pains'. The gift of 'easing pain' by its 'vital moderate heat' had been noted by Dr. Caius, Physician-in-Chief to Queen Elizabeth I.

This toy-dog was possibly brought to Europe by the 'peoples of the sea', presumably the conquering Phoenicians when trading along the Mediterranean,

(Below) A small dog is prominently placed in a painting ot the meeting of the first Chapter General of the Order called by Master Raymond du Puy (1120 to 1160) (Right) Grand Master Antoine de PaUle (1623 to 1636) with a very human faced Maltese dog. This painting IS in the Grand Master's Palace, Valena

with Malta and Carthage among their ports of call. Queen Dido of the Carthaginian's adopted it as the white emblem of her ba nners.

1 he Greeks and Romans claimed this little dog for their own and, together with their prick-eared white toy of the Pomeranian type, indiginous to Europe, called it 'Callis Melitei' - whether after Melita of the Mediterranean or Melita of the Adriatic was a matter of opinion among them.

The smaller newcomer, however, never lost it ldentity and reached such heights

Canis Melitei

(Above left) Tobias and the Angel Verrocchio and when he went forth to depart the young man's dog went with him .' (Apocrypha) His father hired a man to go with Tobias on a journey not knowing that the man was the Angel Raphael. (Above) An enlarged detail of the painting to show the Maltese dog. The Angel Raphael strides rapidly along the road, his feet avoiding the stones, his robes tossing In the breeze The sporting little dog keeps pace with him with obvious enjoyment (Photos. National Gallery)

of popularity thaL it appropriated to itself the name Ca nis Meli Lei en Lirely, and is now the on ly dog from that era to retain this name.

Aristotle speaks of it as 'Canis Melitei of fhe tiny sort'; Strabo as 'being not bigger thun common ferrets or weasel yet not small in understanding or devotion nourished for pleasure and accounted the jewels of women '. Fashionable ladies 'carried them ill their sleeve' while men about town took them even to the ba ths. As a 'sign of politic' and good faith, the Canis Melitei of both breeds were sent as gifts of diplomatlc missions and 'ate off gold from the hands· of queens'. In the fast-expanding empire of Alexander the Great, the little Canis Melitei became one of its predominant exports. In Tibet and China the dogs were bartered for silk, then in great demand in Greek and Roman society. It wa as the favourites of Chinese emperors that they were fir t clipped 'lion-fashion'.

After the fall of the Roman Empire, the breed in the West deteriorated to the point of extinction but, with the improvement of conditions in Europe, trader brought back from the East the descendents of the tiny dogs that had travelled ou t so long ago. These returned to Europe still bearing the name 'Canis Melilei'. Some had been crossed with breeds of the same type and were of two colour. Others that had not been crossed had 10 t none of the characteristics of their ancestors and remained pure white. Great attention was again paid to their size and exorbitant prices asked for them.

'Of all the canine pets,' ays Stonehenge, 'this breed is tile most lovable, extreme(v animated alld sagacious, full of natural tricks, being naturall,v clean and capable oj instruction

In the West they again became the companions of European monarchs and the elite in general. [t is said that Crusader 'carried them in saddle-bags' when they set out to liberate the Holy Land.

Thus the famou Canis Mehtei with its store of legend backed by written record of classical writer of renown, pas ed quite happily into the religious art of Christendom.

On canvas and fresco of Flemi hand Italian masters, in Dutch wood-carvings and French tapestries, again and again one finds the white silken coat of the Maltese dog.

This spirited but gentle little dog, often depicted witha quasi-human face, is frequently seen at the feet of the Madonna or the Saviour, giving rise to the conjecture that the uncomplicated man of old believed the Mother of Christ to have owned a Maltese dog. Even the temporary yellow markings on the ears of some puppies are said to derive from the light shed upon their ancestors by the laying on of hands when our Lord himself blc) ed them.

AND TODAY

by D. Collins

The Maltese dog, once known as Maltese Terriers, have a history that goes back further than that of any of the toy breeds.

It is not certain where they originated from, but Strabo writing in A.D. 25 said 'There is a town in the Sicily called MeHta, whence are exported many beautiful dogs called Canis MeHtei'. There is also a beautiful painting of 'The Last Supper' with a very small white dog in the foreground which is believed to be a Ma ltese.

They are quite smail, weighing from five to seven pounds, pure white with a long silky coat, jet black noses and very dark brown eyes. Mo t intelligent and very game, they are not, as most people

think, content to sit on ilk cushions all day. Faithful to their owners, they have becom'e more popular in recent years, often winning t h e toy groups at championship shows. They are exported to mo t places round the world.

The breed wa alma t extinct after the last war but, thanks to one well known breeder who toured the Continent and brought back several pecimens to breed from, the number of registrations has risen con iderably.

(This article is published by kind permission of the authors Miss Iveria and Mrs Collins, and also the editor of the Council of the Order of Sf. John for Somerset's Year Book.)

(Left) Portrait of a man and his wife. Jacob Jordaens, at Chatsworth, Bakewell, England. The wife points proudly to her husband's staff of office - with a Maltese dog at his feet. (Photo: National Gallery)

Maltese dogs today. (Above) L oulou. (Right) Descendents of 'aristocrates of the ancient world who ate off g old from the hands of queens'

TRIANGULAR BANDAGE

from J oh n E. D ane

I was particularly interested in the Deputy Commi sioner-inChief's history of the triangular bandage in At Rand o m , Ma rch issue When I began first aid it was still called Esmarch s triangul ar bandage in First Aid to the Injured ', as it was in the fir st e di tio n by Surgeon Major Peter Sheppard published after he w as kill e d in action gallantly sacrific i ng his life for a c omrade at Isandula i n 1879

There is a sequel to the Esmarch story told in the bi o graphy o f Sir James Cantlie , who was one of the c oadjutors in the publication of Sheppard s Script and a notabl e pi o n ee r and advocate of first aid.

In 1884 an International Health Exhibition w as h el d in London and in connection with it a Medi c al and Sanit a ry Exhibition was organised at South Kensington Cantl ie, wh o w as a n active member of the Congress , proposed that dem o nstr atio n s in ambulance and first aid should be given . This was even t u ally arranged to take pl a ce in Hyde Park under Dr. Cantlie ' s dir ec tion He had been tea ching first aid to the Metropolitan Poli c e for some years and an urgent request o Scotl a nd Yard br o ught a well trained team of police From the St. John Ambulan c e Association came a second team from th e Medi c al St a ff C orp s a third, and from another sour.ce a fourth w as se cured.

A patient who suppos e d to have a broken leg w as tre a t e d b y the police, who applied truncheons to each sid e of th e b r o k en limb. Their armlets from the left cuff they us e d f or sec uring the truncheons to knee and ankle With their belts they ti e d the tw o limbs together. A doctor who had been w a tch ing the demonstration c ame up and asked Cantlie in a s trong G e rm a n accent , 'What are those pieces of wood ?' Cantlie e xpl a in e d th a t the pieces of wood were poli c emen 's tru ncheon s whi c h w e re applied to a broken leg as a temporary splint. Ah said the German , I see. I am Dr. Esmar c h. I have taugh t the w o rld military ambulance now I know how to tea c h civil ambulance .' On his return to Germany he assembled classes at Kiel Univ e r sity to teach this new branch o f medicine.

During the war the Civil Def en ce Cas u alty Service s w e r e supplied with the Samway s tourniqu e t , which p ro ved t o b e unsatisfactory and wa s withdrawn. It wa s r e pla c ed by E s m a r c h 's tourniquet, which c o n s isted of a rubber bandage wi h tapes a t one end for securing the bandage when i t h a d been a ppli e d rou n d the limb firmly enough t o c ontrol th e ble e ding. Aft e r the war thi s became standard fir st ai d equipm e nt until tourniqu e t s w e re no lo nge r accepted as satisfactory treatment.

Croydon John E Dan e

COMPETITIONS

from Lil ian Ril ey, Di vision al Su pe r in t en d ent

With the advent of another comp et ition seaso n I am i m pe ll e d to write on a matter which ha s worr ied me for the pa s tw o o r thr ee years ; namely , the rules gov e rning eligibility fo r SJ AB competitions

I have been enthusiastic about the value of c ompetiti o n s o the average bona fi d e St. J ohn member sin c e they were re s umed a fte r the last war. At that tim e I enjoy e d th e c hallenge of m ee ting other enthusias ts Thi s surely is the o bje c t o f th e wh ole e xer ci se?

Recently , my d i vision has made a co m e- b ac k o n th e competition scene and I a m dismayed t o find that the wh o le spirit has changed. More often than not we ar e pitted a ga in st professional teams some of whom have t o ld m e they get ( p a id) time off work to go on intensive competiti o n-training c ourses, and all of whom are paid for their first a id servic es. I alwa ys under s tood that the Brigade wa s a volunt a ry org a nisation, and members forbidden to take payment of any kind

However, with the situation a s it s t a nd s in mind , I enqu re d if I mig ht inc l ude an SEN in my d ivision 's entry for a District First Aid competit i on, sin c e one of my regular t e am was unabl e t o be pre s ent that day ; my a rgum e nt b e ing that SENs do n o t in cl ude

READERS VIEWS

Readers v iews and op ini o n s, wh.ich should be sent t o the Edito r , although publ shed are not ne cessa r ily endorsed by t he Edi t or or t he Order of St John and I ts F ou n da t ions. Al t hou gh readers may sign pllblished et te r s With a pe n name, write rs m ust supp ly t heir name and address to the ed tor

f r s t ai d n th ei r h os pital t rai ni ng. I h ave been informed that thi ca nno t b e co unt ena n ced. Ca n someone tell me where the d i vi ding-l in e is dr awn - a n d why?

A s m atte r s sta n d, ordinary divislOns (who do the bulk of publi c d uties an d are the B rigade) who are striving to improve t h e ir effic iency vi a compet ition are being di couraged from e nt eri n g, si nce t h ey can n o t give the time to the s lick-training of full-tim e t ea m Wh en t hey ente r unsuccessfully , and the resu lt s a r e publish e d in the loca l Pr ess (and t h e pub lic not knowing the se t-up) h o w b ad is t h is for the image of the Brigade? H ave you l ooke d a th e r es ult of the Dewar Sh ield Competition since 19 60 ? Th e li s is in t he D iary.

I s it n o t ime that the structure wus revised? encourage the pr ofe ssio n a t ea m s by a ll mea ns, but let them compete on a d iffere nt leve l. C a n we not go buck to square one and examine th e r easo n s for the ins t itution of competitions in the first place?

Un t il so m e m ove is made, [ fear m any division will not make t h e e ff or t , or in c u r the expe n se of submIt ing an en try and t rav elling t o t h e ve n ue.

Pres ton Lilia/1 R i/e.l'

ACCIDENT ACTIO N

from P L. Ferrier , Manager St John Council for S Au tr ali a

I e n c lose A cci d e nt ActlOl1, a booklet de igned to give the untr ain e d at leas t so m e idea of procedures to follow if they come a c r oss a ro a d acc ident an d h opefu lly t o encourage motorists

ge ne r ally t o und e rt ake a fu ll co ur e of fi r t aid.

C r e d it fo r h e pro d uction goes to L ions' Club authorities and o ur own S1. J o l1n in Ad e aide, supported by the AustralIan

Fed e r a l Gove rn ment, w h o in the final outcome perhaps played t he m ajo r role - th at of financlllg the pnnting of 1/2 million co pi es Initi a l d is tribu t io n re po nsibility rested with Lion' C lub m e mb e rs, via petro l se rv ice station out ets, nnd the booklet is also b eing iss u e d t o a ll s tu dents at driver t raining schools conducted by th e Ro a d Safety Counci l. We even tu ally hope to see 'Accident

A ctio n ' in eve r y ne w car so l d and S1. John will take up the issuing o f t h e b ook let in t h e mo r e sparse l y popu lated outback areas of thi s s t a t e . G ene ra l di trib u tio n h as been Austra in-wlde and we fo r esee th e nee d for a r epri n t before very long.

Th e b ook let was la u nc h ed by our Sta t e for re sul ti ng in t e levis io n a nd other new media coverage, followed up by h a lf- p age fea tur es for four week in a weekend newspaper.

Thr ee d ays a ft er the firs t iss ue, we hac! proof positive of an untrain e d mo toris t m os t se n s i bl y atte ndi ng t o t h e b locked a irway of a n acc ident vi ctim a nd th e re b y poss ibly sa vi n g a ife. lI e ha d re c eiv e d hi copy of ' A cci d e nt Ac ti o n fr olll his works ' safe t y offi ce r 2 4 h o ur s b efore

We fee th a t thi s is a n exce ll e n t examp le of wha t can be ac hieved by th e joint efforts of a

AMBULANC ES

AND YET

ANOTHER

Severe External Bleeding by Dr.

A Y DAY any time, anywhere, you may be faced with a man, woman or child who IS bleeding from some injury. I am referring here to external bleeding which can be seen. II ere, then, i a man who has been hurt. H e is in pain and is frightened for be sure that anyone who ha been hurt afraid, and some are downright terrified and you all know how the SIght of blood care some peop le. Severe hleeding kills. Along with mall1tailllng a clear airway, control of bleed ing is ani m med ia te necessi ty. H ow do you dea l with this injured man'? Sp eak to him ca lmly and quietly, and ge n ly pers u ade him to sit or l ie down. F i n d where the blood is coming from, a n d carefully uncover the wound. Y ou must be ab le to ee what you have to treat. L ook alld assess the sIze of the wound, the amount of the bleeding, if t h ere is anything in the wound, if there i deformity, if there is obvious broken bone. Unl ess the r e is an obviously broken bone, raise the wounded l im b in the air.

Do n t be afraid to raise a limb a leg to right ang les with he body, an uppe r limb above the head. Y ou may be surprised by ho w much that alone will reduce the blee di ng; but remember, bl ood does not like flo w ing u p h ill any more than water. If b eeding i still going on, there only o ll e way to s op it by pre su re. Bl oo d vessels are soft-wa ll e d ubes, a nd if th ey are c ut or t o rn , b ood will flo w o u of th e o p en e nd un ti l t h i is s t oppe d up. Squ eez ing the s id e of t h e t u be toge th er by press u re wi ll t op t h e bl ood flowing.

So r ight away, after l ook ing at the w ound, put pre sure on with ha n d or

finger, right on to the point of bleeding, or as near to it as you can get. Books call this 'Direct Digital Pressure '.

Fi n ger p r e sure shou ld be 'changed as soon as you can do so, to pressure by pad and bandage. Cover the wound with a sterile dressing or clean gauze, or the inside of a clean ha n dkerchief, or clean white paper. Do not use lint, nor put cotton wool next to a wound. After the dressing, come a pad. Be ure to u e a b ig one. With a large wound let the padding fill the wound and rise above the skin leve l. Let it e x tend over the skin for a couple of inches or m ore beyond the wound. Then fix it we ll with a fi rm ba nd age, a nd keep the limb raised - on a chair, on cu hions i n a slin g H ow much pressure i needed? Ju sufficient to top the bleeding. You do not want to cut off all the blood to a limb. If the limb goe swolle n and b lue and numb, there is too much pres ure. Watch the area carefully, adjust the bandage if it get too tight, add more packi n g and ban d a ge if a n y h ood how through.

While you have been doing all this, what about our hurt man and hi comfor t ') Y ou will have bee n to h im, and you will h ave a ke d him if he h a any more pa in or hurt. You will find out ho w the accident happened. You will try to reassu r e hi m an d a far as you can yo u will e ll hi m wh a t yo u ar e doing a nd why. H ave you noticed t h at people wi ll often t ell you h ow mu c h i t helps them to k n o w what i bei n g done for them? ow you mus t exami n e for, and dea l with, a n y other njuries, a n d all the time you m ll st

Allan Wa lker

try to make the injured man co m fo r table. R emember it is more comfortable to lie on a couch or to be llPported in an easy chair, than to lie on the hard grou nd K eeping the head low still allows for one low pillow. Cushions or folded blankets under an injured lim b suppo r tin g covering blankets by a cage over an injured limb, all help towards comfo r t. If you can keep clearly 111 fron t of your mind that you are dealing, n ot so much with an injured leg or arm, a w ith Tom J one or J enny Smith who is hurt is in pain, is afraid. you will not be likely to forget about his or her comfort. All the time you must be watchi n g your man" condition hi colour, hi breathing, how alert or otherwi e he is, the rate and volume of his pulse and recording 111 breathing and pul e rate.

If he has evere wound " If he has lost a lot of blood, he must go to ho pital traight away. Severe bleeding, two pint or more, requires urgen t tra n fu ion, an d the soo n er the better. 0 waste no time and give no dri n ks, however thirsty he may claim to be.

The les , er injury which can be dea lt with at home or can be ent to hi Doctor's urgery at his next session, nee d not be denied hi cup of tea. After the b leedi n g ha heen dealt with and the mess cleared up, a cup of tea may add con iderably to t he co m fort of both the casua lt y a n d the fir t-aider!

All thi' may o u nd eleme n tary, ye t cannot be stressed too much. Loss of b lood kills, and every first-aider mu t be able to dea l with uch an emergency.

(R eprill ted frol17 The Electricity COllneil's A IlIbula ll Ce Bulletill) 19

NEW from SCOTLAND

Are we snobs?

IS THE Order of St. John a bastion of snobbery? I raise this awkward question because I must surely not be alone in meeting people who have not joined the association because they have believed it to be just that. I have tried to get these critics to analyse their feelings and to tell me what it is about us that they find so distasteful. Generally speaking two criticis ms are made, neither of which in fact corres p onds to the dictionary's definition of snobbishness. It is felt that we are dominated by members of the aristocracy or the professional classes who are concerned less with the ideals of the Order than with the social perks that go with the work involved. These m em b e rs, it is said, may work hard for t he Ord er but to them this is less an end in itself than a chance to associate in a pleasant way with others of their kind while at the same time smugly believing t h at they are 'doi n g good'. And it is also argued that the two-fold character of St. Jo hn - as an Order of the Crown and also one which claims a very long and co lo u rful past - results among members in a mystique in which the Order itself, its history, grades and ceremonies, becomes more important than the duties for which it was founded.

My readers will know that these attitu d es caricature the truth. But it is wo r th asking ourselves whether they are justified in any way and, even if they are not, why well-meaning people can be led to believe the m One could not deny that the well-to-do and the distinguished are prominent in the Order, but the reasons for this are not hard to find. Charities, which demand a lot of hard work and cannot, should not, pay salaries, have to depend on the voluntary participation of those who have the means to do so, or are retired and have time on their hands. And an institut ion which, in England at least, has long been rooted in county associations, has a para-military organisation and cl ose links with the diplomatic and military services will natu rally gain support from the grandes dames in the counties and retired diplomats and military men. It could not survive without their help and, since men do not usually become distinguished for nothing, it would be odd if those who had had success in other fields did not occupy the higher echelons. It is, moreover, quite untrue to see their participation as dilettantism, for many of 20

them work long hours on thankless tasks with very little reward.

Neither can one deny that the Order 's' esprit is an important element in its life . But so it should be. The critics overlook how closely our ideals are reflected in our history, the study of which ought only to confirm and underline our responsibilities. In this respect the past history of the Knights of St. John is a priceless asset which cannot be used or expressed enough. And if some are attracted by the pomp and ceremony rather than by a real desire to care for the

sick, then this gains us a few more hands and a few more subscr ip tio ns, and it seems to me harmle ss. I WOUld, therefore, di smiss these criticisms as stemming from ignorance, but that is not to say that I feel we should ignore them. We ought to ask ourselves two questions. First, are we imaginative and gentle enough? Grand accents and clipped military voices may exercise a natural authority over some, but they can also te rrify many ordinary people. Upper cia s mores can attract, but they can also repel: and are a few potenti al workers lost through occasional thoughtlessnes and tactlessness?

Secondly, ought we to stress our hi toric role not in terms of knights and battles, of fortresses and ieges, but in terms of the absolute commitment to the care of the sick poor? Ought not our history to make us humble rather than proud, as heirs of the' erf of our Lords the sick', rather than of the mighty defenders of Rhodes and Malta?

WALES

OVERSEAS NEWS

After the se vice (L to R) Deputy Commissioner Long, Commissioner Riggs, Rev. Gwilym Williams, Assistant C omm issioner Sam Sage, and Rev. Emrys E v ans

P ERHAPS the finest tribute to the late Dr. Howel B. Pierce, K.SU., - a medical practitioner in Mountain Ash for 50 years - was the fact that so many local people attended an impressive service at St. Margaret's Parish Church recently.

A magnificent black-and-gold memorial standard for use at St. John functions was dedicated by the vicar, the R ev. Gwilym Williams, in honoured memory of Dr. Pierce, a former St. JolIn Commissioner for the Aberdare Valley; members of the family, plus close friends and St. J ohn personnel, were present among a most representative gatheringa real cross section of the population.

The sermon was preached by the Rev. E Emrys Evans, Moderator, South Wales area, Presbyterian Church of Wale s and former pastor of Bethlehem Chapel, Mountain Ash, where Dr. Pierce worshipped.

Mr. Evans in a short, effective and sincere tribute quoted from the

Scriptures : ' Hon our the doctor for his services'. He recalled the Memorial service on the day of Dr. Pi erce's funeral, when he had referred to the Doctor's valuable contributions to various committees, bodies and organisations.

'T he Honour he valued most was when he was made a Knight of the St. John movement,' said Mr. Evans, 'and his best epitaph would be the St. J ol1n motto, which includ e d the words 'for the service of mankind.' This service wa s an act of thanksgiving for one who had erved his generation so nobly and so well.

The service was conducted by the Vi car. Lady Ffrangcon Williams, Presid ent and Chairman of the St. John Council, read the lesson, deputising for The Prior, Lord Aberdare, who was unable to be present. The standard bearer was Commissioner R O. Riggs , snpported by Deputy Commissioner T. ]. Long, and Assistant Commissioner Sam Sage.

The death occurred on February 28 of Mr. Carmelo Garzia at the age of 72. Mr. Garzia joined the St. John Ambulance Brigade in September 1926 as a private with the Cottonera Division after gaining the First Aid Certificate. Subsequently he qualified in hygiene, sanitation, home nursing, and child welfare. In 1938 he was awar ded the Long Service Medal and from 1939 to 1945 erved WIth the Air Raid Pre-

cautions Organisation as Secretary at H.M. Dockyard, and gained the Defence Medal. In 1946 he was admitted to the Order as Serving Brother in recognition of services rendered during the war. At that time he also formed the Pawla-Tarxien Division and was appointed its Divisional Superintenden t. The Meritorious Certificate was presented to him for special services in 1947, and in 1952 he was appointed Corps Officer of the newlyformed No. 2 Corps. During the Golden Jubilee in 1959 he was promoted to Offi cer (Brother) in the Mo st Venerable Order. He was a very efficient Lay Lecturer and was very busy all the year round in this line, in fact he was actually running a Fir st Aid Course when death cut it sho rt Mr. Garzia gave 47 years of very active and efficient service to the Brigade and it will be very difficult to replace him for some time. The esteem in which he was held by one and all was fully demonstrated during High Mass de Requiem held in his Parish church which was very well-attended by many members of his family and frien ds.

Mr. Garzia was very well-known by m em bers in the U.K. and other countries mainly through personal contacts and also through his acting as host to the many St. John parties who visited Malta Edward Tortell

National First Aid Competition Results

ELECTRICITY SU PPLY A

Area)

6. South Western (Pool, W. Cornwall)

7. South Wales (Llynfi)

8. Merseyside & N. Wale (Capenhurst)

9. South of Scotland (Bathgate) 10 North Eastern (B lyth )

South Eastern (S. E.

5. Yorkshire (Sheffield)

6. North Eastern (Tynemouth)

7. North Western (Lakeland Area)

8. Midland (Birmingham) 9. Eastern (Essex) 10 South Wales (St. Mcllons)

Southern (Marchwood)

In view of the very large distances between towns and villages in Kenya it is not always easy to obtain expert medical help quickly in the event of a road accident - and it is often the provision of immediate, efficient first aid that is all important.

In an effort to prepare for such an emergency twenty-seven first aid posts have been established along the 481 kilometres of the main road to Mombasa from Nairobi.

This is a joint project by the Kenya Red Cross Society, who provide the materials, the St. John Ambulance Brigade, who train the personnel, and the Automobile Association of E.A. who help to maintain the sign-posts, and replace boxes as they have been used.

The first aid posts are situated at railway stations, police posts, and at the gates to some of the national parks, and the personnel are all members of the railways, the police and park rangers, who are re-examined regularly in their knowledge of modern first aid techniques. The boxes contain basic dressings and bandages , antiseptics, simple analgesics, a blanket , torch, umbrella, and some water, and have already proved very useful in a number of accidents on that busy main road.

MALTA

KENYA

News from

the Divisions

County Supenn tendent Mrs. J Horsey ecently presented Grand Pr io r Awards to 4 Wlmborne ex -cadets Janet Keynes, Marylin Sutton, Margaret Co x and Mary Chegwidden who a re now in the adult division.

( Pho to: Simon Rowley Ringwood )

BERKS - Following the success of West Berkshire's area competition in 1971 and 1972 it was decided to hold them again in 1973 but with a new format.

The teams, which were mixed consisted of '2 adult and 2 cadets. the individual tests the adults and cadets had to deal with separate incidents.

A very realistIc was simulated for the team test , an accident involving two ca ualties in a log- awing competition at an agricultural show. The individual test for adults a motor cycle accident, while cadets dealt with an overdose of barbiturate tablet.

There also a separate compel1tion for nursing pairs. The adults had to deal with a patient in bed with a heavily bandaged leg, and the cadets had to take the temperature, pulse and respiration of a patient and prepare her for a bed-bath.

Trophies were donated by various presidents and staff officers and the prizes for individuals were kindly donated by Wallace Cameron &. Co Ltd. , of Gla gow. Brigadier T. E. D. Kelly, CBE, County Commander, presented the pnLes.

NORFOLK - Gorleston and South town Cadet Division was showered with praise by the County Commissioner, Brig. F P. Barclay, at its first enrolment and prizegiving ceremony for many years.

He saId that he had not .,een a cadet D i vision win so many certificates. Describing it as 'a crackll1g good show', he went on, ' I am most deeply impressed particularly wit::' the leadership which has achieved th is.'

H e congratulated the Divisional Superintendent tll·sing Cadets, Miss J. Smith, who took over in ]970 , and Divisional Superintendent Ambulance Cadets, Mr. P J. D anie ls. 'It is marvellous to gain so many new members and build up such a division in so short a time,' he said.

Fifteen Nursing and four Ambulance Cadets, aged 12 to 15 years, were enrolled by Mrs. A. A. Ettridge, County Staff Officer Cadets.

The first six cups, to be given by the division, with SlX miniatures for the winners, were presented by Brig. Barclay.

YO R K S North Riding Whitby Ambulance Division members attended two horse-riding accidents recently. The first was at a point-to-point meeting when a rider feU after a jump. SJA members treated him but later it was learned from the hospital where they took him that the casualty was paralysed from the neck downwards. The next day another fall resulted in the rider having severe lacerations of the head. He was treated on the spot and then taken to hospital. Supt. Kennedy and his men were twice complimented by the hospital for their handling of these serious cases.

Sheffield Corps, ursing Divisions, had an overall decrease of 7 members during 1972, the total now being 89. Members attended 1,471 duties, involving 7,594 hours, during which 186 cases were treated.

OBITUARY

WI LLI A \1 I:,WTO, Offi ce r, Cramlington Ambulan ce Division, Northumberland.

\1\SS 1:,. M. PA \lTI G \fBl:., Swindon o. 3 District British Rauways (WR Centre) for the past 35 Serving Sister. A. E. SIIORTRIDGE, President Caterham Ambulance Division.

MRS. DOROTllY Y STUDZ, ursing Member, No. 17 Ley ton and Leytonstone Division Serving Sister. Died March 17 1973.

CHARLES lOll UPWARD, DiVIsional Officer, home Ambulance Division. Serving Brother. t\!RS. DOROTY Y ARKER, Divisional SuperIIllenucnt, East Oevcland ursing Division. Serving Sisler.

REVI EW CROSSWORD No.5 (73) Compiled by W. Potter

ACROSS:

I. Early arrival requiring warmth. ( 9 .4 ) 9. Attempt an addendum in digestive ferment. (7 ) 10. Alcoholi c drink from globe in orbit. (7) 12. Blood in the right side of the heart. (6) 13 Sting arm in a strange way to produce this sort of pain. (8). 16. Low-grade mental defective. (5). 18. High-pitched voice from pharyngeal tonsil. (4). 19 Food regime in old assembly (4) 21. A quid to masticate. (4). 22. Shows signs of advancing years. (4). 23 Simple organisms in the slime. (5). 24 Cartilage of Xiphoid process from re-shaping of firm nose. (8). 26. Carrot chopped for use with cannula in paracentesis. (6). 29. Hearing drums. (7). 31. No amber for humerus. ( 3-4). 32. State in which there is lack of response to stimuli. (13)

DOWN:

2. Ready for radiographic examination of artificial silk ? (5 ). 3 . Doctors leave nothing for malarial vector. (8). 4. Have an inclination to nurse. (4). 5. Painful condition of muscles and joints prevalent in cold, damp climates (10). 6 Bertha initially takes left ear to make eyes dim with tears. (5). 7 Unpleasant smell with a large snake. (3). 8. Multiple fractures of ribs and sternum causing severe respiratory distress. (5-2.5). 11. Gay with cardiac atrophy? (5-7). 14. Sweet layer may impair safety of aircraft. (5). 15. Learner to annoy German boy in insulin-producing islets of pancreas. (10) 17. Obstruction of the bowel. (5). 20. Apparatus producing tears. (8). 25. Incandescent gas for rapid, emergency sterilisation of surgical instruments. (5). 27. A blow for an old rag. (5). 28. Brag about dress. (4) 30. Many with article for male. (3).

SOLUTION TO CROSSWORD No.4 (73)

ACROSS:

1. Bad blood; 8 Relapsed; 9. Rough.age 11. Eschar ; 12. Ages; 13. Ream; 15. Ass ails; 17. Apex; 19. Goose ; 20. Liver; 21. Lens; 23. Isolate, 26. Thaw ; 28. Bear; 29. Setter ; 30. Add.uct.or ; 32. St.enos.is; 33. Tenotomy.

DOWN:

1. Borborygmi ; 2 Bug ; 3. Otalgia ; 4. Dr.ess; 5. Sleeps; 6. Specia.1ist; 7. Detail; 10, Urea; 14, Muscle tone; 15. A.x.on ; 16. Strawberry; 18. Pale; 22. Stand-in; 24. S.heat.h ; 25. Thrush ; 27. Halt; 28. Blast; 31. Cut.

News from the Divisions (contd.)

(Photo

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A Guide to Films on FIRST AID, NURSING

ST. JOHN REVIEW

Order now - £1.70p. for a year's subscription includ ing postage , and don't forget bulk orders of 6 or more copies a month (minimum 3 months) at a special rate of 10p. a copy including postage Review Sales, St. John Ambulance, 1 Grosvenor Crescent

A Visit to Headquarters p.2

US Gift to Ophthalmic Hospital p 3

Head Injuries by R A. Elson, MB, FRCS pA

First Aid for Riding Accidents by Rayner Thrower, MD, MRCP p.6

Around and About by the Editor p.8

Resus citation by J. P. Payne p.12

Films p.16

SJA South Bucks now has both by Brian R ockell p 17

Readers' Views p.18

News from Scotland Wales p.20

Northern Ireland p.21

News from the Divisions p.22

Books p.24

EDITOR: FRANK DRISCOLL, 26 Pembroke Gardens, London, W8 6HU. (01-6038512)

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£1.70 per annum, including postage, from Review Sales, St John Ambulance, 1 Grosvenor Crescent, London SW1 X 7E F.

I n the month of St John 's Day - June 24 - Cadet Sergeant David Abratiam, of Dartmouth IS our cover sto ry 16- year-old David, a ca det for 6 years, holds the Grand Prior badge, two Special Service Shields, and was recently awa rded the Pillar cup for outstanding service to St John and the publiC In Dartmouth Soon to be promoted to the adult diVISion, David wants to be a doctor (Pho to J. G. Cozens, Dartmouth)

AT RANDOM

by Watkin W. Williams Deputy

I A HODSI G ESTATE called Dpperby, on the outskirts of Car li sle, is a new St. John headquarters 'wi th a difference'. It is designed to be a 'St. J ohn Ambulance Community Centre' to cater for the increased social needs of the neighbourhood, as well as a headquarters and training centre for the Brigade. The building is well appointed, with a main hall, a large separate room suitable for committee meetings, a small room equipped with bed, etc, for nursing training, an officers' room, a room to be used as the County Secretary's office, kitchen, store room, and lavatories. Outside, there is plenty of space for parking, outdoor training activities and possible future building extension, and a garage for two ambulances.

Apart from the county office, the building will be regularly used by a combined adult division and a cadet division, and on special occasions by other divisions and for conferences, training days and so forth. Plans are also being made for its regular use to provide facilities for handicapped teenagers , a daytime play school group and an open youth club, as well as social activities for old people.

On a sunny afternoon on the last Sunday in April the building was formally handed over to the Order of St. ] ohn by the Lord Lieutenant for Cumberland and dedicated by the Bishop of Carlisle. Later, a Thanksgiving Service was held in a nearby church, and the Bi hop preached a splendid sermon on the text 'Four men were carrying him' It wa a very inspiring service, with the church packed to the doors (almost entirely with people from the immediate neighbourhood) and 'standing room only' for the last to arrive. The date happened to be exactly a year, to the very day, since my visit to St. John in Cornwall, and on both these occasions 1 wished that many more of our members who live and work in less remote and more populous parts of the country could have been present to share my inspiration and joy at finding the spirit of the Order of St J ohn so splendidly maintained in the furthest corners of our land.

Stock-taking

All properly run organisations have occa ional periods of stock-taking and forward planning, and the moment when our St. John Cadets have just set forth on their second half-century of existence is perhaps a good one to take tock of our present position and to plan for the future. The undoubtedly successful achievements of the past fifty years must not lead us to become

(Continued on page 11)

A Visit to

Headquarters

US GIFT TO OPHTHALMIC HOSPITAL

A CHEQUE:. for 3,000 dollars to facilitate the work of cornea l grafting at the St. John Ophthalmic Hospital In Jerusalem was presented by the InternatIOnal Eye foundation I nc. of Washington to the Hospitaller of the Order of St. J o11n's hospital on I\.pnl 24. The presentation (photo) was made by the Director of The E:.ye FOLlndation, Dr. J ohn [larry King JI1f to the Il osritaller, Mr. T. Keith Lyle, at an Informal cerernoll) held Jt St. John' Ca te.

At the congress for the alliance of Orders of S-t. John held at the Ophthalmic I [ospit,li III JerLlsJiem IJst autumn dIscussions tooh. rldce between Dr. King, Dr. B,11 ten, the hospitdJ'S warden, Dr. the \lll eflCan ophthalmiL surgeon who performs the cornedl gr;ifting operations, and Dr. Lazar, the head of the ophth,limiL' departJlJent of the khitor II 0spit:1i in Tel \viv. Following tilesc talks the (-<ye Foundation :Igreed to spollsor the aPPolntmcnt of a hIghly qualified technician to worh. Jointly hetween the two hospital· 111 order that the vital work performed on corneal grafts could be increased, for Jews and Arabs alih.e.

The I nternatIOnal Eye F ounda ti on I nc. IS an o rgani sation eomprising eminent ophthalmic surgeons from a llover the world. It ohj'ct IS to help under-developed countries: to promote

the science of ophthalmology amongst all nations; and to sponsor both eye surgical knowledge and teaching teams on ophtha lmology The adYisory board of

the Foundation consists of surgeons from each country of the world. The Hospitaller of the Order, Me T. Keith L yle, is the board's British representative.

Head Injuries

CONTINUING LAST MONTH'S ARTICLE ON THIS

IMPORTANT SUBJECT FOR THE FIRST -AIDER

By R. A. Elson, MB FRCS

I N LAST MONTH S article Head Injuri es, the type s of injury to which the brain could be subjected and the ana tomy of the parts concerned were describ e d. In simplest terms , it was explained how mechanical shock at the time of injury could cause:

(a) Concussion (minor brain damage) - short-lived unconsciousness le a ding to rapid regaining of consciousness.

(b) Longer periods of unconsciou s nes s (major brain damage) - followed by slower regaining of consciousness, and al ways associated with bruisi ng , laceration or compression.

The longer periods of uncons cio u sness in more severe head injuries with major brain damage are always associated with longer periods of loss of memory for events immediately preceding the injury.

There has always been some compression due to swelling of the bruised brain inside its closed box , the skull, and this together

with la ceratio n, is the cause of th e greater loss of brain function; if this tense swelling does not soften, so that the pressure inside the skull can r et urn to normal, the brain tri es t o extrude itself through the hole in the floor of the skull and, in so doing, the vital brain stem leading to the spinal cord becomes stretched and comp re sse d ; her ein lie the nerve ce ll s which co ntr o l respiration and heart function; if these are paralysed by the co mpre ssio n, death must supervene (see diagr ams A and B). (As will be o bserved again lat er, compression can be due to bleeding).

In some of the really bad injuries in which the head has been st ru ck at high velo c ity , as in a car accident when someone not wearing a seat belt is ejected through the windscreen, serious laceration can tear the brain or some other vital part, an d d eath is immediate. In other cases with seve r e compression

due to brain swe llin g and laceration, the loss of consciousness can last for many days or, in some ca es, become permanent in the last terrible situation, the patient has a useless living body with no brain to govern it.

In more fortunate instances, In which the compression may have been severe but not progressive so dS to involve the vital centres , slow recovery of conscio usn ess occurs, but the patient may retain some permanent evidence of brain damage such as a muscle weakness, impaired intelligence, tremors, or he may start to have fits. The latter arc due usually to scars in the brain where it has been lacerated, for slIch are<ls can act JS centres of abnorm(]1 electrical activity which trigger off bursts of abnormal brain activity.

This short account of the results of major brain damage (i.e. severe contusion, laceration and assocwted swelling leading

to compression) present with unconsciousness or a very low leve l of co n sc ousness a nd this is appare nt to the first-ai d er from th e outset. The most valuable informatio/1 the doctor can receive from the reliable first-aider is a deSCription of any changes of level of consciousness which ma), have occurred during this early phase of the palient's posl-head injury statc. First Aid manuals tC<lch methods of recording the leve l of consciousness and the rules should be adhered to strictly. The other important sig ns such as I1Ul1il size, l1ulSe rate, rcsl1ir(]tion, movements of parts of the body, assume greater import(]nce in cases with the lower levels of consciousness and, in the completely uncon CIOUS, they are the only guides which will tell us if deterior<ltion is occurring.

The pre ervation of the airway is the only vital <Ispect of treatment which the first-(]ider must conduct and, while observation is important, it is not desirable to exhaust the patient by over-frequent questioning, prying open the eyes and shining bright hghts, and other exce sively enthusiastic measures.

The regular a es ment at fifteen minute or, at the most, ten minute interva ls, is all that is required for observation unless some dangerous event like airway obstruction should occur.

Compression from Haemorrhage It is well known that, even after apparently relatively mIld head injuries, deterioration can occur due to haemorrhage inside the skull. Last month It was explained how sLlch bleed IIlg could be arterwl or venOllS. Both Cdl1 lead to large blood clot which compress the brain from WIthout and can

C A Similar result to that in

by

press it down on to the floor of the skull, tending to drive it out through the h ole leading to the spina l cana l and, as occurred in compressio n from brain

swe llin g, cause stretching or nipping of the vital brain stem centres (see diagram C). As the bleeding develops and the cerebrum becomes pressed-upon by the clo t, t he level 0 f consciousness deteriorates or, in some cases, if cells supp l ying nerves to the muscles in some part of the body become irritated, the part may move outside the contro of the patient or, a lt ernalively, become paralysed. Fits can occur.

The essential thing to remember is that any head injury with minor or major brain damage can be accompanied by intra-cranial bleeding and, if this progresses, the clinical state deteriorates. ff this deterioration occurs in a patient who has recovered consciousness after a brief period of unconsciousness, the first-aide r is unlikely to miss it; however, if the deterioration occurs in a patient with major brain damage, in whom the level of consciousness has remained depressed from the outset, it may be more difficulL to detect and only careful assessment, and careful recording with accurate time when the observation were made, will show up the change.

r n the absence of bleeding or progressive brain swelling, all head injuries tend to improve, however slowly, and it is the onset of a deterioration or some change in the signs which may mean a clot is developing.

Finally, we must describe one of the most treacherous type of haemorrhage and subsequent compression; this is called the chronic subdura l haemorrhage. It occurs following a head injury which may

be so minor as not even to have produced concussion; it occurs more commonly in children or el d e rl y peop le. A small haemorrhage and clot formation takes place in the sub dura space, but at first it does not ca u se any compression. Gradually, however, it en arges, not by continued bleeding but by forming a cyst. Now, a cyst is a flu id- filled bag an d the subdu r al clot changes into this state when the blood liquifies and forms thin fluid in the cl ot centre. This fluid contains much protein, which attracts more fluid an d the cyst expands Eventua lly , the expansion is so great that cerebra l compression an d , later, damage to the vital centres results; untreated, the patient can die.

The most notable feature of the chronic subdural haemorrhage is that its s low development can occur months after the minor head injury, which may have been entirely forgotten. Accordingly, a ll head injury patients and their close relatives are warned to return for m edical advice should any unusual mental behaviour, weakness, fits or othe r abnormality be detected, even long periods afterwards.

Throughout this article, 1 have stressed the importance of the first -aider as a source of vital information. All head injuries of sufficient magnitude to have caused unconsciousness, however brief, are usually admitted to hospital for observation of the level of consciousness. The earlier this observation can be commenced the better, and in this respect the competent first-aider has the best advantage. Accurate observations, recording these and thE· times they were made, are of inestimable value to the doctor who takes over the ultimate care of these common injuries. SU MM A R Y

The Oinical Picture Concussion

Swelling - com pre ion

More prolonged unconsciousness usually improving, however s owly, unless com pression gets wor e

Blood clot (ex tradural or sub dural) causing com pres ion

Progre sive det erioration whieh may be rapid or slow , depen d ing upon how quickly bl eed in g occ ur s

Usually accompanied by so me br ai n da.rnage but thi s may be very minor. Blood vessels can be torn

A abov e, depen ding on pos si bl e br ain or vessel damage

5

Diagram

Diagram

diagram B but ths time caused

a blood clot Again, note how the brain is pushed over to the left and how the vital centres are affected

First Aid for Riding Accidents

ONCE COMMON KNOWLEDG E WHICH IT IS BECOMING INCREASINGLY NECESSARY T O RELEARN

IT IS RECKONED that about a million people are now enjoying the different forms of riding becoming so popular: h acking, hunting and pony trekking. As long as horses have been ridden there have been occasional accidents and how best to deal with these was common knowledge in days when horses provided the only form of transport. Now the lessons of the past about ways to handle accidents are having to be relearnt and re-applied. Even in open country first aid given with few facilities greatly influences the su b sequent course of events.

Prevention

As F l orence Nightingale repeatedly said when pioneering medical and nursing progress, if something undesirable can be prevented why not prevent it? Accidents due to the use of worn or faulty tack can b e avoided; likewise those from a badly adjusted spur strap which may catch in a stirrup and drag a fallen rider. Always the importance of wearing hard hats cannot be over-emphasised, even while exercising, much of which has to be done in some districts on slippery roads with motor cars rushing past regardless of

anybody. At times of course the circumstances a-nd" effects of riding accidents are unpredictable s uch as those caused by a strand of old wire in an innocuous looking green fence. It is said, probably with truth that the wor s accidents occur with a tired rider on a tired horse : the rider is not fully alert and the horse is allowed t o slop a l ong and stumbles or shies at something ignored under better circumstances.

Any nurse, doctor or first-aider who rides will be called upon, soo ner or lat er, to help someone after a fall. Fortunat ely few falls onto soft ground cause serious injury but onto hard ground the effects can be bad Many riding accidents occu r in remote places far from proper ro a d s or even houses so anyone de aling with the situation ha s two problems to face. First, how best to render first aid with little equipment or assistance; and second, how to get the patient transported safely to civilisation.

M ini m u m E quipment

By simple improvisation a great deal can be accomplished to mak e anyone reasonably comfortable an d , what

by Rayner Thrower, MD, MRCP

vitally important, to prevent injuries from be comi ng aggrava t ed during removul to a house or hospital. While no one would even suggest that kits are practicable, ther e is o n e simp l e item I h ave ca rri ed in my pocket for many years; that is a triangular bandage in a flat. thin waterproof e nv e lope. Be ca u se of its likely uses the bandage shou ld be of the tough army variety, not the common lightw eight sorl. While the bandage may not be u sed ve r y often it always justifies pocket space if only to have something with which to dry your own neck at the end of a day after a soaking In addition, other useful items are a knife and a piece of string which anyone riding should possess anyway. With this simple equipment and stirrup leathers it is possible to tackle most jobs likely to be met.

Types of Injury

Obviou sly it is llnpossible to list every kind of injury which may be encountered but there is a remarkably wide v8riety. It ... is commonly supposed that the bone which suffers most IS the clavicle. Thi, is true among jockey, and others riding

ra ce h orse. under s traightf orward co nditi ons. But o ut hunting and in ordinary cou ntry riding acc id en t s [ hav e see n m orc lo n g bones brokell o r di s located han collar bones. And don't [o rg et that, when a clavic le is broken, particularly after what is common ly ca ll ed a crashing fall, it is not Ullusual for one or more ribs to have suffered also. Bones in the lower extremities are usually damaged when a limb gets caught underneath a fallen horse.

Cases 0 f severe concussion are fortu n ate l y uncommon when the rid er has the protection of a good hal. But anyone who has had a bad tumhle , and possibly lost hIS hat, is often dazed: then a quick deci s io n may have to be taken as to whether there has been real concussion a decision that may not be easy. If nothing else has happened the rider is usually anxious to remount and go on. Still it IS as well to p lay for safety after any head injury and to encollfuge a genLie had, home or. if you ure In doubt about the situation, a ride on four wheeb.

How to Cope

P rovided a reasonable appr<Jiscli of the ike ly dumuge has been made, any over-detaIled exuminatIOn In the field is undeSIrable when someone has obvJOusly been injured. For insLJnce, If there is a suspected fracture below the knee leuve it as cl suspicion: simply tying the boot to the otber one WIth strips of hundage will provide temporary rixatioll Should the bandage be needed for a sling you cun still cope. Tie the feet together WIth your piece of string and use a couple of ,tirrup leathers, above and below the knee. to secure the injured purt (Fig. 1.).

Last year taking a short Cll t when hunting, I found a m:1I1 who hud taken toss and was obVIously very distressed, lYIng on the ground. A glance revealed that one foot W.IS ying externully rotated, the puthognol1lonic sign of serious damage to the femur, usuully a i"ract u re, 0 r mo re ra rely, a rorwu rd dislocution of the hip JOInt which I have seen happen after a riding accident (Fig. n

While I was wondering what to do With my own restive horse a Land /{ over merCIfully appeared. Strips of bandage and le;lther temporarily re tared alignmcnt using th e sou nd II111 b as a spl inL Thcn came th e prob lem of removal over rough country whIch only a Land R over could cross, to the nearest furm to await aillbulalll·e. One of us went to find help to lift the patient into the ve hicl e and IIlIS was done successfully. Despi t e wb:lt proved to be a comminuted of thl' femu r, the man is riding with o ut disability. Thi s inciuent raises the matler of th e best form of initi:t1 transport It) USl' :lfkr LI seriOlls :Il'cldenl. I n gone by I here were stories of peo pl e bL'lng c:lrried on LI g'lte. But wooden i":lrl1l :IIT hl':lvy

r·

Fig. 3 Injur ies to the ches t o shou l der region. 'If the band age is used for fixation then an ordinary tie o r a sti rr up leather can be adjusted for a sling'

things at the best of times and to carry someone for any distance must have meant four men, and men are now getting scarce in the country. The modern tubular steel gate IS fairly Itght. likewise a sheep hurd e, but these are poor substitute for a stretcher. H owever, a prolonged wait in the cold for a stretcher does no one uny good and much can be accomplished in the back of a La nd Rover with its tail board horizontal and using a little imagination.

Emphasi on the value of improvised fixation al 0 applies to injurie to the che t and shoulder region. As you have only one triangular bandage a decision must be taken whether to tear it into strips for fixution purposes or to u e it as a sling. I f the bandage is used for fixation then an ordinary tie or u stirrup leather can be udjusted for a s ling to ease the downward pull of upper limb weight (Fig. 3). But alway, what to do for the be t depend o n whut can o nl y be the immediate rough :1l1d ready diagno i of the trouble. A broken clavicle may be obvious, but not so broken ribs or even a broken humerus. To try to take off jackets to muke sure abou t the trouble is to be avo id ed without good rcuso n At best it will only add to the pain, while s impl y a jacket o n will help to plint temporarily un injured forequurter.

Spinal Injuries

pin a I lnjuril's l11U t be st'riously, if o nl y because carl'kss handling often makes ll18tters worsc. Remember that njuries to the sp inal L'nrd are soml'ti Jl1 l's irreversible u nd may result in permanent paralysis in the lower cxtre1llltles. Thc na turl' and extent of thesl' inJurie ' vary so mucil that it is

impossible to provide more than general guidance, ind eed there is sti ll much discussion abou t the best way to handle such patients in diffi,cult circu m stances. Id eally, spina l casualties are best lifted and transported on a stretcher by trained men and - after motor smashes or in mines, where such injuries mostly occur, there is no delay in obtaining skille d assistance. My surgeon friends tell m e that, in a remote spot, a person may well suffer more fro m prolonged delay or possible exposure while await Ing a stretcher party than by reasonably carefu removal in the back of a suitab le vehicle. The important thing is not to disturb anyone too much before carefully lifting him, without any sagging into the rescue vehicle. fn cidentally, it is good to have someone in the back of the vehicle to ease the patient in, so to speak. Any reasonably comforta bl e position assu m ed on the ground is often the best position in which to place the patient for transport. Such a position can be maintained with coats or rugs and possibly someone squeezed alongside t o provide additional support. If the condition of the patien seems reasonable in the improvised transpo rt it may be better to drive straight to hospital r athe r than risk more disturbance by transfer to 8n ambulance half-way.

P itfalls

Many cuts and bruises are of no significance, but some regarded at first sight as slight must be co n sidere d as possible markers of something more serious underneath. Thi s i particularly important if there is a ny suggestio n that the fallen rider h as been kicked afte r the fall. I h eard about a man who e liver was ruptur e d by a kick though, at the time, there was little locally to su gge what had really happened. I alway think about such possibilities. The nature of most kick inj uries i self evident and there is not a great deal that can be d o ne immediately beyond applying the general principles of first aid with which, of course, :lIly nurse o r d octor i familiar.

Anything in the nature of unconsciousness, wh ether transient or otherwi e, demand that the victim be not left unattended until there is so me ind ication of how seriou the situatio n is. I think if I were confronted alone by someone unconscious I w ou ld wait a wh ile to be sa tisfied about hi s position and t h e presence of an 8irway. If no one appeare d th en the only possible action would be to leav e the patient us sufe ly as pos ible and spee d off for help. When an injured per on on the ground, whether un conscio us or not, it r ema rkable how small adjustments of position with, say, a rolled jucket under the head can make li fe more tolerable for th e m ome nt. T h a ve felt someti me that this so rt of thing is ove rl ooked even by helpful by LInder.

(Reprinted

AN IDEA

The County Superintendent (N), Sussex, re p orts: Southwick Division held a reunion for all past Cadets. They worked hard to contact as many as possible, and as far and wide as possible, and it was a great success. It also brought into contact with the Brigade again many ex-cadets, quite a lot Grand Prior holders, who had married, some gone abroad and lost touch. It was found that some had come home to Sussex to live, and with their families now growing up we hope that some will consider becoming active members again. I can recommend this idea to other counties. We hope to gain a staff officer from this reunion

County Superintendent (N), Gloucestershire, reports : that a wine and cheese party, organised as are-union of 'Old Cadets', was greatly enjoyed.

ANON

Another anonymous donation has been received by the Order - a £2 postal order with a note simply saying: 'I had a small win on the pools'.

BUSY 36 HOU RS

While RN frogmen were searching the hull of the Queen Elizabeth 2, after the ship docked at Southampton on April 12, members of 215 (Royal Borough of Kingston upon Thames) Division went aboard to collect a patient, so that he could continue his journey from New York to Dublin.

The ambulance crew, Div. Sup. D Spracklan, N/O D. Long and A/M P Rooney, after picking up a relative of the patient in New Malden, arrived at the Southampton Docks by 8.30. After various security checks they were allowed on board to meet their patient and start the journey to Liverpool in time to catch the night ferry to Dublin.

and ABOUT

WH AT'S GOING O N IN THE WORLD OF ST. JOHN

BY THE EDITOR

Arriving in Dublin the patient and N/O Long were met by an ambulance of the City of Dublin Corps, manned by Sgt. S. McGrath and A/M W. Leppla , thus co mpleting a long journey to Meath Hospital.

The intention was that after s t aying the night In Liverpool , Div Sup. Spracklan and AIM Rooney, with th e ambulance, were to visit members of the Preston Corps to continue ties established when 215 Division provided an ambulance member for the 1972 Pr eston Guild, but this did not materialise For during the morning the Division received a request for transport of a patient from Farnsworth, Lancashire, to Islington. With the help of the Southampton Do ck police a message was passed to the crew regarding their new route home. N/O Long 's journey home was not without incident. On the ferry his cabin and others were broken into. Money was

APPOINTMENTS

Priory for Wales: Bailiff of St. Davids, Sir Cennydd Trahernc, KG, TD, JP , MA , LLD. Chancellor, Sir Mi chae Duff, Bt. , JP. ViceChancellor, Mr. E. W. Meurig

William s, MCh , FRCS, MB, BSc.

Bristol : Lt-Colonel A II. Thompson to CSTJA. Major W. 1. Greener (currently Area Comm.

Somerset) to Comm.

Yorks: ( Rid ing) Brigadier C. C. Fairweather to CSTJA. Colonel J.

M. Forbes to be Comm. (W. Riding)

Captain M. G. Hutchinson to CST JA

Uganda : Lt Col. (Dr) G. Bogere to Commissioner. Mr. L. K. [dro to Dep Com.

Kenya: Mrs. C. A A. Everard to Executive Officer ( HQ ), Vice Mrs E. S pyra tos.

Correction to Appointments April

Review

Derbyshire : Mr. Colin H owe is Commissioner Peak Area. Major B. A Meadows TO is Commis ioner Derwent Area.

stolen from other passengers ; all he had stolen were bandage s from his first aid bag.

In all the ambulance was away for 36 hours , covering 602 miles.

WARNING

An article in the British Medical Journal, Automati c Transmission Vehicle Injuries, begins with: 'Four drivers sustained severe injuries when run down by their own automatic cars while adjusting the carburettor or throttle linkages. The tran mission had been left in the Drive' position and the engine was idling This accident is easily avoidable.'

So automatic transmission car drivers beware.

CADET PROJECT

The following is from Area Supt. (N) Miss Y. M Leather , of Thetford, orfolk : Following an urgent appeal from the orwich Branch of the Save The Children Fund for children's clothes, blankets, and toys after the icaraguan Di sa ter , I organisl:cI a collection among the Cadet Division in entral South Area, orfolk. There was a good response from five divisions , one of which made some delightful toys as well as collecting other itpm<;

I feel that this is a very sUItable project for cadets. The local secretary of the Save the Children Fund was delighted with the car load of clothes etc. which 1 took over to Norwich. She tells me that the Fund is in continuous need of these things, as they are sent all over the world including Northern Ireland. After the Nicaraguan Disaster their warehouses were quite empty. It is also particularly appropriate as Lady Mountbatten was the S .C. F. President.

See photograph below.

MISS PANTING MBE

1 shall have to watch out when I travel by British Rail, especially if 1 pass through Swindon. For in the May obituary column r 'killed -off Miss E. M. Panting MBE, secretary to BR's Swindon Works' manager , and who R ETIRED early this year after 35 years with BR

Miss Panting joined Swindon Central Nursing Division in 1940, to resign 8 years later for domestic reasons. But she has continued her association with St. John ever since as an active member of Swindon No.3 District, British Railways (WR Centre).

During this time Miss Panting served on the District Committee for two separate periods, and was secretary of the Ladies' Class from 1962 until retirement. In 1969 she was awarded the MBE for services to first aid and National Savings, and last month she was invested as Serving Sister of the Order.

Miss Panting will continue to do all she can to advance the first aid movement in her retirement. Which I trust - without my interference - will be a very happy and long one.

TEASER

A teaser by Geotge Jukes, lay instructor SJ A Kidderminster, which he tried on Kidderminster Nursing Division recently, follows. See if you can shake out the answers - and then, and only then, look them up on page 24 of this issue:

I. Five children are brought to St. John Ambulance for treatment.

2. Jill injured her arm.

3. J oan was taken away by coach after trea tment.

4. A roller bandage was used to hold a dressing in place on the person with a hand injury.

5. James had his dressing held in place with a triangular bandage.

6. The person with the hand injury came in immediately after the person with a leg injury.

7 The child taken to a friend's house was taken by car.

8. The doctor's surgery was where the chi ld with the trunk injury was taken.

High S h er r iff, Cdr. Colin B alfou r ; the C ountess of Br ecknock, Chief Pr esident; the M ayor of W ncheste r Lady Ashbu ton; the Earl of Malmesbury; L ord Ashburton; an d the Cou ntess of M a mesbury

9. Tubular g<:luze was used for the middle child.

10, Jack was the first to be treated.

1 l. The child taken to hospital next to the one taken by taxi.

12. The child taken to the doctor's surgery was next to the one taken by ambulance,

13. The child taken back to school was treated by using elastic net.

14. Jack was treated next to the person with a he(Jd I11jury.

15. J anet was taken home after treatment.

Each child has one I11jury, taken to one place by one method of transport, and has the dressing held in place by onc method.

Wh o w as ta k en away by van?

Who w as treate d with ad he ive pIa ter?

OLD CROCKS

Cobham Division, Surrey, are holding a steam engine and vintage car rally at Wisley Airfie ld, with many other attractions, on June 16 and 17.

TO N. IRELAND

Two Devon County Council <:lmbulances were handed over recently to Superintendents George Hogg and Andrew Shilliday from Newry and Londonderry by the County Director SJ A, Devonshire. (See photograph left).

These ambu lances were purchased by S J A Devon from the County Council and the two superintendents were flown to E x eter Airport to drive them to Liverpool fo r shipment to Be fast. Also in the photograph arc Mr. R. P. Selley the County Ambulance Officer and Mr. F. Creber, Chief Engineer, Devon County Council.

[n addition to the two ambulances, Exe t er City Ambulance Service a lso presented S J A Northern I reland some dozen tretchers and h<:llf a dozen boxes of bandages and other first aid equipment.

AVAILABLE FROM

The book I:.mergency Treatment of Casualties price ,f: 1.30, and reviewed in the March 1973 Issue, can be obtained fr0111 the Local Government Training Board, 8 The Armdale Centre, Luton, LU I 2TS, Beds. Some readers have had diffinllty in obtaining copies.

NEW BROCHURE

A new 16-page brochure on safety in the

use of medical gas cylinders has been produced by the medical gases department of The British Oxygen Company Ltd, Medical Equipment, Elizabeth Way, Harlow, Essex CM 19 5AB, from whom copies arc available free.

The publication has been prepared for reference by all personnel involved wlth medical gas cylinders and provides vital information on the correct procedures relating to storage, handling and usage.

I AT RANDOM (conlinuedfrompagel)

complacent, and if we arc honest in our efforts at stock-taking, we shall fJl1d there are very few cadet divisions to which one or more of the following weaknesses do not apply:

I 1 he number of officers is too few in relation to the total Ilumber of cadets, probationary cadets and junIOrs in the division, with the result that officers find themselves trying to train too large numbers and too Wide an age group at one and the same time. 0 cadet division with only one officer should have a total of more than 14 members, and one with two officers should not have more than '27 (see B. R. 20). This means that m<:lny divisions should have a waiting lIst until a larger number of suitable people can be found and trained as officers. [t may seem hard-hearted to keep keen recruits w,lltlng, but it's no kindnes to accept them in larger numbers than we (;(In train effectively, and the mere fact of havlllg a waiting list can be a tremendous incentive to keenness. To avoid having to deal with too Wide an age group, (a) juniors should not meet at the S,lme time as cadets if only one small hall IS available, and (b) the older cadets should sometimes be taken separately from the younger ones.

2. The number of cadet leos IS often far below the establIshment laid down in Brigade Regulations (again, see B.R. '20). I t be regarded JS quite normal for corporals to be aged 13-14 and ergeants aged 14-15, and that most of tho e aged 15 should be cadet leaders adets are made NCOs so that they may receive trainmg and practice in leadership, and not primarily to hel p the officers, bu t if they are properly trained and used thel'r help will in fact be immense (though we must recognise that there are bound to be occasional failures). Special meeting should be held from time to llme to trJm NCO in what they are expected to do and how to do It. Previously trained and briefed, they can orten give simple instruction to small groups of cadets, and they should be u ed as group leaders in practical work and realistic Jctivity projects. They should also be encouraged to offer and discllss ideas for the divisional programme. All cadet sergeants and two other elected members (in a cadet division these two would normally be cadet leaders or corporals) should serve on the DIvisional Committee (B.R. 122) which an e sentJaI part of a well run division. Cadet leader and leos can (if properly trained) plan, organise tind put aero activitie for the whole diVision, and they should certainly be encouraged to do so occasionally.

3. Many divisions don't make enough use of out ide expert he lp, especially in proficiency subjects and in t h e frequent use of casua lty simulation. There are plenty of suitable people ready and wil ling to help if asked: and if some of these are members of an adult division, so much the better for strengthening the link between adults and cadets. R ecently [ wa taken to task by an officer on a training course for saying that 20 minutes at a time wa quite long enough for cadets to re eive instruction on anyone subject at a divisional meeting, becau e it was c ai m ed i t wo ul d be <:I n ins u lt to a visiting instructor to ask h im or h er t o come a n d speak for 20 m inutes on y. B u t [ remain u n repen an , for the n struc t or ca n be asked to g ive 20 mi nutes' in s t r u c ion, fo ll owe d by 20 m inutes' pr actica work, an d fina ll y 2 0 m inu t es' gr o u p di sc u ssion o n w hat h ad b ee n ac h ie v e d ; a te rn a ive ly, in a large di v is io n he co u ld gi ve 20 minut es'

Data on the management of medIcal gas cylinders for pIpeline installations is also provided.

A special section details the' action that should be taken in cases of fire.

The British Standard colours used in cylinder identification are displayed on a fold-out chart which also gives dimensions, weights and capacities.

instruction to each of three groups in succession.

4. Divisional programmes are not challenging enough to hold the interest of cadets for more than two or three years at the most. This harks back to <:l subject that I wrote about last month, and we must certainly take a very close look at our programmes to see that our cadets not merely enjoy them but find a continuing sense of fulfilment and achievement as a result. Do we make our range of proficiency subjects stimulating and interesting enough for all the ages covered? Do we explore all opportunities of service to our local community so that our cadets can cover a wide range of Brigade duties and other forms of service? If we do, then a steadily increasing number of cadets will have the satisfaction of gaining the Grand Prior's Badge and more an d more Special Service Shields. But we must see to it that what they have earned, they receive quickly, for nothing is so damping to enthusiasm as having to wait months to receive and disp l ay the visible award of our achievement.

[f we go forward on these lines, we can be sure that far fewer cadets will drift away at the age of 13 or 14 than, to be frank, we are losing at the moment, and that many of today's cadets will be senior members of adult divisions in the cadet centenary year 2022, proud to look back on a lifetime happily dedicated to the service of mankind.

Bitter sweet

Professor Yudkin, who tends to view life in starkly contras ing black and white and to admit no delicate shades of grey, recent l y wrote to The Times an impassioned appeal that we should all give up eating sugar. He claimed that sugar is a contributo r y cause of many non-infectious diseases that kill; he describe d it as 'a substance for which the body has absolutely no physio l o gi ca need', and said that there was strong evidence that 'the inclusion of sugar in the diet does not prolong life, but shortened it'. Thi news sent a chill through the heart of S i r Noel Arke ll , who confessed that all his life he has had a swee t toot h and protested that in his 80th year he is still generally w e ll , e njoys life and never walks les than half an hour daily. S u r e l y,' he continued, 'sugar has one or two good points? My S t. J ohn's F irs Aid to the I njured book says this about first stimulants for the shocked patient: "Give strong tea or coffee with ple n ty of su ga r ". Another good point must su r ely be that sug a r in hone y , chocolates and sweets gives great p l eas u re. I s that o b v i o u s fac t goi n g to count as no t hing? Eating s ug a r re m i nd s me of t h e ac t o f kissing, which the health exper s say is bad an d d a ng e r o u s a nd ye t which is as popu l ar as ever it w as."

O u r Surgeon-in-C h ief, Co l. Oll erensha w w as t h e ne xt to en e r the lists, tho u gh unlike Erasmus he ref u se d to b e d ra wn a b o u t his views on kissing. H e d eclared himself 'pe r sonal ly a s t ro ng A r kellite, in spite of what it does to m y fi gur

professionally I should be an equa

Y u d ki n i t

But [ am afra id that the m a r ch of progress has et Si r ot! d o wn " H ot s w e et tea" wen t out with t h e 1958 e di tio n of th e m a nual a nd curr e ntly t he a n aest h et ists d

Resuscitation

A TECHNIQUE AS OLD AS THE HISTORY OF MEDICINE

by J. P. Payne

IT IS A COMMON belief among laymen and possibly even among some nurses and doctors that the evolution of resuscitative techniq ues is a relatively modern development associated with the introduction of patient monitoring equipment. [n fact, resuscitation is as old as the history of medicine and certainly goes back to Biblical times. [n the Old Testament, for example, we are told how the prophet Elisha revived the child of the Shunammite woman who had befriended him : ' and he went up and lay upon the child and put his mouth upon his mouth and his eyes upon his eyes and his hands upon his hands; and he stretched himself upon the child; and the flesh of the child waxed warm.' (Bible, 2 Kings, Ch. IV, v. 34) (Figure 1). In addition, the New Testament contains several accounts of Christ restoring life to individuals apparently dead, albeit by the exercise of supernatural powers rather than by the application of techniques readily available to all.

Although the interest in main taining life was established in earliest times, progress was slow at first and it was the latter half of the 18th century before satisfactory methods of resuscitation began to become recognised. Figures 2, 3 and 4 illustrate three early methods of artificial ventilation. Among those responsible for this d evelopment perhaps John Hunter was the most outstanding. The scope of Hunter's interests

1. P Payne, MB, CHB, FFARCS, is the Direc tor of the Research Departm en t of A naestlietics, Royal College of Surgeons of England, Lin coln's Jnil Fields in Londoll

embraced virtually the whole of medicine and included consi deration of methods suitable for the r esuscita ti on of the apparently drowned. In a r emarkable essay published in 1776 Hunt er described a method of resuscitation whi ch does not differ substantially from that us ed today with the exception that external cardiac com pression is not included. He emphasised that failure of respiration wa s the primary cause of death in victims of drowning and that car diac failure was secondary. He argued therefore, that if help was forthcoming immediately, regular inflation of the lungs would be sufficient to restore life but that th e prospects of recovery were diminished by every moment of delay.

Top ro duce effective ventilation

Hunter designed a pair of bellows: 'So contrived with two separate cavities that by expanding them, when applied to the nostrils or mouth of a patient one cavity may be filled with the common air, and the other with air sucked from the lung s; and by shutting them again, the co mmon air may be thrown into the lungs , and that which is sucked out of the lungs be discharged into the room.

If during the operation of th e bellows, th e larynx be gently pressed against thG oesophagus and spine, it will prevent the stomach and intestines being too much distended with air. This pressure however mu st be conducted with judgment and caution, so th at the trachea and the aperture into the larynx both be left perfectly free.

l would advise lessening the application of air to tile lung, and enjoy those employed to ob erve with great attention when the muscles of respiration begill to act, that our endeavours may not interfere with their naLural exerlions yeL that we may be still ready to

This description of the management of artificial ventilaLion is a relevant today 3S it was when it was written and there is added interest in what must be the first published account of the use of a negative phase in intermittent positivG pressure respiration. With the aid of his bellows Hunt er carried out the sa li ent experiment on which his view') on resuscitation were based:

'The muzzle of the bellows was fixed into the trachea of a dog, and by working them he was kept perfectly alive. While this artificial breathing was going on [ took off the sternum of the dog, and exposed the lungs and heart: the heart co ntinu ed o act as before on ly the frequency of its action was considerably incr ease d. Wh en I stopped the motion of the bellows the hearL became gradually weaker , and less frequent in its co ntr actions, till it entirely ceased to move. By renewing the action of the bellows the heart again began to move, at first very fain tly and with ong intermissions; but by continuing the artificial breathing, its motion became as frequent and as trong as at first. This process I repeated upon the same dog ten times s::Jmetimes stopping for five, eight, or ten minutes, and observed that every tim e [ left off working the bellows the heart became extreme y turgid with blood, the blood in the lefL side becoming as dark as that in the right, which was not the case when the bellows were working. These s ituation s of the animal appeared t o me exactly imil ar to drowning.'

The significance of Priestley's discovery of oxygen a few years earlier had not been lost on Hunt er, who in a footnoLe to his paper suggested that 'Perhaps the riephlogisticated air described by Priestley (oxygen gas) may prove more efficacious than common air. It is easily procured and may be preserved in bottle'i or bladders for that purpose'.

Of equal significance was his recommendation that, when other methods had failed, electricity could be used to stimulate the heart directly.

Hu nter condemned blood-letting on the grounds that it further weakened the patIent thereby impeding recovery, and he WJ'i equally oppoed to the use of the common remedy of tobacco fumes which he argued also weakened the patient by provoking sickne s or purging according Lo the route of administration.

Although iJunt er was the first to Investigate the problems of resuscitation in scientlfic detail others before hIm had practised some form of artificial ventilation, notably William To ach (1744) wllo described the successful resuscJtation by mouth-to-mouth ventilation of a miner overcome by fumes:

'When he came to the mouth of the pit, which was between half an hour and three quarters after he had been left in the bottom of It his eyes were stanng open, a nd his mouth was gaping wide: his skin was cold; there wa not the least pulse in either heart or arteries, and not the least breathing could be observed: so tha t he was in a ll appearancG dead. I applied my mouth close to his and blowed my breath as strong as I could, but having neglected to stop hiS nostrils, all the air came out at them: wherefore, taking hold of them with one hand, and holding my other on his breast at the eft pap, I blGw again my breath as strong as [ cou ld raIsing his chest fully with it, and immediately I felt six or seven very quick bea ts of the heart: h is thorax can tinued La play and the pulse was felt soon after in thG arteries.'

Tossach's description aroused the

interest of J ohn Fothergill (1746) who proposed that: 'The method of distending the lungs of persons dead in appearance having been tried with such success in one in tance gives just reason to expect, that it may be useful to others'. Fothergill went on to suggest that:

'It may be a proper enquiry, in what cases, and under what circumstances, there may be prospect of applying it with success.

various casualties' in which this method migh t be tried not withou t a prospect of success; some of them are the following: suffocations from the sulphureous damps of mines, coal-pits, etc; the condensed air of long unopened wells, or other su b te rraneous caverns; the noxious vapours arising from fermenting liquors received from a narrow vent; the steam of burning charcoal; sulphureous mineral

Figure 1 Elisha s mouth -to - mouth method of inflation, 800 Be

Figure 2 Paracelsus method of inflation, AD1530

Figure 3. Barrel method of resuscitation, AD 1700

Figure

h o w f a r t hi s m e t ho d m ight be successf ul in r e li e ving su c h as m a y h ave unh ap pil y bec ome th e ir o wn exec u ti ons, by h a n g in g th e m se lv es. It migh t a t leas t b e tr ie d , f, aft e r th e c rimin a l s h a v e h ung the us u a tim e, infl a ting th e lun gs in t h e m an n er pr o p os ed , w o uld n o t so m e tim es br ing them t o li fe. Th e o nl y ill co n seq u e n ce t h at co uld acc ru e f r o m a di scove r y of t h is kind w o uld b e eas il y o bvi a t e d by prolonging h e a ll o tt e d t i m e o f su s pension. But thi s m e th o d w o uld see m to promise very mu c h in a ss is ting th ose wh o have be e n s uff oca t e d in th e w a t e r , und e r the abov e -m e ntio n e d c ir c llm sta n ces; a t le ast , it app ea r s n ecess ary t o reco mm e nd a trial of it a ft e r th e bod y ha s bee n di s charged o f th e wat e r a dmitted int o it by pla c ing it in a proper po s iti o n th e head downward s, prone , and , if it can b e, across a barrel hog s head o r som e such-like c onvex s upport with the upmo s t e xpediti o n.'

It would appear that Foth e rgill s view s 14

F igu r e 7 P ocket case of resuscitation equipment designed by Dr. C. Kite and desc r ibed by Dr. J Savigny (1789)

F igu e 6. F r ontispiece of a Tr act pub ished in 1782 on r esuscitation and oxygen a d ministration

were large l y ignored by his contemporarie , but at least his s u ggestions seem lo have aroused lI1terest.

In A Collection of Authentic Cases, Pr oving the Practicability of R ecovering Persons Visibly Dead bv Drowning, Suffocating. Sti/ling, SlVooning, Conl'lIfsiol1s and Other ACCidents, pub lished by A l exander J ohnson In 1773, the following description of the resuscitation of an I rish tailor hanged for rob b ery occurs:

'After the ru l prit had wa lked to the ga ll ow. an d been turned off a adder, as customary in those parts of I re land. havi n g hung 29 minutes within a few seconds, by a s t op walch, and shewed no signs of li fe after the first four minutes, h e w as, on the Sheriffs re iring, cut d ow n , a nd ca rr ied to a fie d near the pl ace of execution, where Mr. G. opened the te m po r a l ar t ery an d t h e exlernal jugul a r , bu t th e c ir c ul a ti on seeme d n t ire ly s t op t , s m a l l por ti o n of coagul at e d b l oo d o nl y appea r i n g at each o rifi ce. Th e b ody was hen s t rippe d , an d th e b ack, mo ut h, a nd nec k rubbe d with a qu a ntit y of v o a til e sp rits a nd oi l. Th e o b acco gl ys t er w as a so a dm in i ste r e d b y m ea n s o f light e d pip es, co v e re d o n t he b o wl with s tr o ng p a p e r pr ic k e d fuJI of h o le s, a nd hi s a rm s a nd le gs co ntinu a ll y rubbed by th e m o b who w e re ve ry num e rou s a nd c h ee rfully aff o rded th e ir assistan ce . [n thi s co ur se they co ntinued from two o f th e c loc k till n ea r s ix in th e

of the officers of jLlstice

'This man afterwards retired to the County of C are, and was "een by several rersol1s within these two years arparenlly 111 good health'.

John Hunter himself bt:Glme involved in attempts to resuscitate at least one condemned man , the Rev. Dr. Dodd, chaplain-in ordinary to K1I1g George Iff (Dobson, 1955). Dr. Dodd. a friend of Hunter and a life governor of the newly established Humane Society was hanged for forgery at Tyburn in 1777. After being allowed to hang for nearly one !tour Dr. Dodd's body was cut down and taken to a house In Goodge Street where IIunter and other doctors attempted to revl ve him. The ir efforts were unsllccessful and Dr. Dodd was buned in the Parish Churchyard at Cowley, Middlesex.

brandy

evening, when Mr. G. made an inCision through the sk.in Into the windpipe in the usual manner, and blew strongly through a canula mto the lungs About 20 minutes after, the blood at the '\ftery hegan to run down the face, and a slow pulse was just pen:eplible 8t the wrist. At this critical period, news was brought that the sheriffs had heard of the steps which were tahn to recover the man, and had sent the constab les and some soldiers to secure the body. The hospitable peasants redoubled their efforts at thi intelligence: a short time after the blood came 0 from the artcry, that It was thought necessary to stop It, which was ea Ily done, by placing a half-penny in a bit of rag, and tying it over the part. A little after seven the pulse beat fainLly near 40 strokes in a minute, the patient's mouth and nose being irritated with a little spirit of Sal. Ammoniac, he opened his eyes. 'The mob, apprehensive of the body being taken from them, placed it on a large board, and, suppor t ing the head and shou ders, ca r ried it in that manner to a vi ll age ca ll ed G las h een, about a mIle and an half from the gallows. H ere Redmond was p laced in a silting posture on some hay in a stable, and With great difficulty swa ll owe d some warm brandy and water. H e gr oaned gr ievioLlsly, and seemed to fee gr eat rain, which was imagi n ed to ar ise fro m t he friction he had undergone, as hi s legs and arms were in so m e p laces exco r iated. Mr. G. t hen left h im t o the ca r e of h is friends; in the night h is s leep w as acco m pa n ied w i dl frequent groans an d sta rt ings. T h e next m orning he was a bl

seemed in

I nsrired by the example of a Dutch Society founded in 1767 to provide instruction in life-saving measures in cases of drow11lng the lIumane SocJCty was founded in 1774 by Dr. William Hawes, Dr. Thomas Cogan and some friends to encourage greater dissemination of knowledge concerning resuscitation by sponsonng lectures, instigating research and awarding prizes (see Figures 5,6 and 7). An early prize winner was Dr. Charles Kite whose cssay on 'The Recovery of the A pparently Dead', published in 1788, contains probably the earlIest of a D. C. defibrillator for clinical u e together With an account of its potential dangers (Figure 8).

What is imrre<;sive about the medical writers of this period was their insistence that knowledge of resllscitative techniques should be unconfined and not restrIcted to doctors. Thus in 1744 Fothergill argued that: 'there are facts which III themselves are of so great importance or which may lead to such useful discoveries that it would seem to be the duty of everyone under who e notice they fall, to render them a extensively public as it is pos ible'. More specifically J ame Curry (1792) emphasi ed:

'that whatever concerns the preservation of human life cannot be too generally known On no branch connected with the science of medicine however, is knowledge less general1; diffused, han upon that which I11dkes the subject of the fo ll owing pages; and to this circumstance only, can be attributed the doubts which we have repeatedly heard professional men express, wllh regard to the truth of the greater number of ca es where a recovery i said to have been accomplished. WIthout some general principles to guide us, we must not only lru:-,t for all farther improvement to the uncertainty and danger of randol11 experimen t but we cunnot even employ to the best advantage, the means which arc a lready known and approved of. To tho e who are entire y ignorant of such

Figure 9. Figu es reproduced from a m 0 n ograph of Herholdt and Rafn (1796) to Illustrate the equipment requ Ired for the res usc tation o the appa ently drowned

principles, every measure recommended must appear as of nearly equal importance: whence the most trivial may be often employed to the exclusion of those that are absolutely necessary, and to the los of much time, if not of the object itself for which all the exertions are made. It may be observed in proof of this. that inflating the lungs has been long spoken of as one of the mean that may be tried; but it only within these few years that Its mode of operation ha been c learly shown and the neces ity for its assiduolls employment properly insisted on; and it is, perhap, to this circumstance chiefly, that we should attribute the greater prorortion of successful case now than formerly.'

This enlightened approach contrasts markedly with that of some modern clinicians who would restrict knowledge of resuscitative lechl1lque to the medical profeSSIOn.

Thus towards the end of the 18th cen t ury the resuscitation of the apparenLly dead had been placed on a rational basis and in a review (Figure 9) of the life-saving methods available two

Danish authors, J. D. Herholdt and C. G Rafn (1796) outlined a plan of treatment aimed at: '( 1) removing all hinderances to the vital functions, starting again especially (2) the re pi ration and (3) the circulation of the blood; and (4) restoring the uppressed energy of the nerves.' I n particular, they gave a detailed d escrirtion of the method of mouth-to-mouth re uscitation as follows: '3 healthy person, ho had strong lungs, should take a deep Breath, press his mouth again t the lips of the Drowned P erson, and then forcefully blow hIS breath into the L ungs of the V ictim. During this insufflation, the no tri ls of tile Asphyxiated Per on were squeezed tighLly together, and according to Monro's directions, the cartilaginous rings of the windpipe (Cartilago Cricoidea) were pres ed back. against the eckbones in order to clo e the gullet (Oe ophagu ), so that the insufflated Air could not e cape through the lose or slip into the Stomach. A little time after the lungs had been filled in this way, the Chest was rubbed and compre ed with the palm of the hand, from the pit of the stomach

upwards, in order to drive out the insufflated air again.

'B ut as the insufflation of Air by mouth is a very Toilsome and Loathsome Act, and since accordingly an otherwist! laudable delicacy of feeling u sua lly prohibits both the Phy sic ian and other P eople of Propriety from using this method, especially in Adults or P eople of advance d years who have been drowned, it is of only little use.'

In th e light of modern experience the good results described in c hildr en might be related to the f<JcL that because the rib cage is more resilient in the young so m e degree of cardiac compression might have been superimposed on the respiratory exchange. The effectiveness of closed chest cardiac compre sion in maint aining the circulation is firmly estab lish ed (Kouwenho-ven, Jud e and Kni ckerbocker, 1( 60)

(Continlled next mOil/II .)

This article appeared ill Teach-In and is reprinted by lJermission of the Editor and Update Publi cations Ltd.

Presumably for the latter reason they a dvo cated the use of chest compression in the following manner: ' If the chest of a drowned person be grasped with both hands, and the Breastbone is vigorously pressed back against the spine, some of thi s Air, together with the water which has entered through the windpipe, will be expelled; on the other h an d, a soo n as the pressure ceases, the Chest is aga in expanded by the action of the e l<JsLic cartilages of the rib, a nd the pu re atmosphere is then allowed to enter in place of the expe lled air. By this artificial compres ion, which invariab ly even in an actually dead body re ults in the expansion of the Chest, the Lungs are seL in moti on, by which the Air entrapped in the Chest i gradua ll y expelled and renewed, so that oxygenation may again occur. So far this simple tr ea tment a nswers the purpose. In Children, whose ribs have longer ca rtilages permitting freer movements of the Chest, this treatment is more efficacious, because a grea ter amo unt of air is exchanged on each comp r ession.'

FILMS

The

FOLLOW THE LEADER (1971) (CoI.10mins.) Hire

Distributed b y: Guild Sound & Vision Ltd., Kingston Rd. London, SW19

This film demonstrates the efficacy of modern emp loyee-centred supervisory practices; it can aid in the development of leadership skills.

The panel was impressed with this film; by means of puppet photography it demonstrates with great lucidity leadership skills. How ever, it is specifically geared to commerce and not entirely suitab l e for other disciplines.

Audi e n ce: Although American in concept this film may have value on le a d ership or office r/ NCO training courses.

THE EARS AND HEARING (1972) {CoI.22mins .l Hire

Distributed by : National Audio-Visual Aids Librar y, Paxton Place , Gip sy Rd ., London SE27 9SS.

Produced by Encyclopaedia Britannia.

The anatomy and physiology of the human ear are shown; eardrum vibrations are seen by the use of stroboscopic lighting. The film also explains causes of partial deafness

The panel co n sidered this a brilliant piece of film-craft that with excellent colour photography conveys the amazing physiology of the human ear. It is perhaps a shade long for its content although the subject matter is absorbing. However it is too technical for other than medical personnel with specific value to ENT students.

Audience Too advanced for St. J ohn personnel.

AIR POLLUTION (1972) (Col. 17 mins .l Fr ee

Distributed by: Central Film Library , Govt. Bldg. Broom yard Ave., Acton, London, W3

Produc ed by: Central Office of Information

St. Bartholomew 's Hospital MedIcal College works on air pollution - scientists collect air samples from busy traffic spots and volunteers undergo respiration and endurance tests.

The panel felt that this film although quite well made deals with a subject not enti r e ly worthy of c in ematographic treatment. The degradation of the environment is a topic of great concern, of course, but this specific investigation and tests even allowing that negative information can be valuable information adds l ittle to film material already in existence.

Audience : This film has no specific value within the Lraining framework of St. John but could be used as a filler.

COAST GUARD (1972) (Col. 23 mins .l Hire

Distributed b y: Central Film Libr ary, Govt. Bldg., Broomyard Ave., Acton, Lond on, W3.

Produced b y: Central Offi ce of In formation. The activities of lIM Coast Guards showing day-Lo-day working and the decisions upon which lives may depend.

The panel considered this an excellent film It is well-made, beautifully photographed and is most informative about the work of the service. It is a shade long for its content and perhaps over dramatic, none the l ess it is very entertaining as well as instructive. It is important for all within SL J ohn to know the capabilities of other se rvi ces, not least within the framework of disaster procedure and this film could be seen by all coas tal divisions with benefit.

Audience: Of universal interest.

WHAT MAKES MUSCLES PULL (1970) {Col. 19mins.) Hire

Di st ribut ed by: John Wiley & Sons Ltd., Baffins Lane, Chich ester, Sussex

Spon so red by : John Wiley & Sons Ltd.

Illu stra t es preparation of micro-electrodes from hand glass tubing and measures the electrical potential across the n1 e mbrane muscle fibres a the micro-electrode tip enters the cell.

This is a brilliantly produced film that is a model of film-craft. V isuals, graphics, etc. are all good and the length is ideal for the subject. It is, alas, way above the heads of our members.

Audience: ot suitable for exhibition to St. J ohn members but will be of great value to specialised <Judience.

THE FRIDAY CLUB (1963) (B & W 27 mins.) Free

Di stributed by: British Medical Association, BMA Hou e, Tavistock Sq., London WC I

Sponsored by The Royal Medico Psy c hological Asscn.

This film shows the participation of patients in some of the Friday Club, (dancing, singing, art) a therapeutic social club for patients from the Psychiatric and Out -Patients Departments of SL George's lI ospita London

This black and white film is a record of club activities and will have v<Jlue only to specialist psycIJother<Jpists and <Jides. It is straight forward smal l budget matcrial mainly for archives.

Audience: Of no interest to St. J ohn member s.

An old and a new ambulance

SJA SOUTH 8UCI(S NOW HAS 80TH

by Brian Rockel! ASO

IT WAS 14 YEARS since we purchased our last ambulance in 195 8, an LD Series short wheelbase Austin. And with hindsigh t we realised the shortcomings that vehic le had ; it was based on a very spa rse design which allowed only primitive stretcher gear to be fi tt ed, it had no visual or audib le warning systems, no heater, and, so unlike an ambulance should be it was black in colour. But the vehicle still sound, having travelled on ly 20,0 00 miles, and showed no signs of rust, so it would have been foolish to scrap it.

Since 1958 ambulance design has altered considerably, especially after the 1967 government report by a working party on Ambulance Training an d Equipment (in two parts), This report recommended the use of trolley stretchers, a standard colou r for ,vehicles (white was suggested), that hazard warning lights be fitted to all vehicles, and many other changes were advocated in the design of vehicles. Local authorities are now comp lying with these s uggestions. For those involved in the equipping and design of vehicles the report, published by H M.S O. at 50p a part, IS invaluable. Few of us realise the far reaching implications that this reporL is having on ambulance training and equIpment.

Considering all this information we decided to purchase a new ambulance to replace the Austin as our front-line

vehicle. We chose the 35 cwt. Ford Transit chassis. This vehicle is economica in cost initially and easy to maintain, an important aspect as we undertake our own repairs. Th e bodywork was coachbu ilt by Wadham-Stringer an d included a trolle y stretcher, full heating, warning syste ms (Fiamm and Luca s), carrying chair and all the equipment necessary to make the vehicle compara bl e with ambulances operated by local authorities. We also equipped the vehicle with hazard warning lights , reflective cones, fluorescent jackets and reflective 'ambu lance' signs. The result is capable of carrying 12 to 14 people in comfort, and able to act as a front - line emergency vehicle should the need arise. The nett cost of the vehicle was £ 1900; it is powered by a 2000cc low compression engine giving a maximum speed of 65 with a fuel consumption of 20 mpg. We have calculated running costs, based on insurance, tyres, petrol, oil an d servicing, at 5p per mile, excluding the inconsistent expenditure on actual repairs and depreciation.

Although it took over a year from the planning stage to date of delivery of the new ambulance (with the Ford strike intervening) this gave us a chance to consolida te OLlr ideas for the conversion of the old am bulance. Initially we decided to modernise the vehicle to

A an earlier date we had equipped this ol d vehicle with a blue beacon and Lu cas electric alternating horns, together with more refined stretcher apparatus and better interior ligh ting.

As we were now able to use the Transit, we undertook the conversion of the Austin. It was res prayed a sparkling white, with reflective 'ambulance' wording on the si des ; repeater blue lights were added to the grill panel, as well as other refinements such as a loading light, hazard warning lights, towel roll, oxygen, etc. The cab had been partitioned off from the rear interior, so we removed this partition and then pain ted throughout the interior.

We found the red reflective 'ambulance' letters made the vehicle very distinctive among normal road traffic and the cost of this lettering was very reasonable. A price list for such lettering can be obtained from Cotswold Emblems, Dr a y c 0 tt, Moreton-in-the-Marsh, Gloucester.

So SJ A South Bucks now has two vehicles, modern in design arid equipped to meet most eventualities for 'u ndertaking our duties.

( Below) The refurbished and modernised 14 vear old Austin ready for plentv of more work (Right) Dedicating the new ambulance (L to R )

A RECORD?

The picture of Gosport's Alverstoke Ambulance and Nu rsi ng Division's 8 past and present members who are members o f the Order, published in the April Review brought the following respon e:

ottingham's Stapleford and Sandiacre Division (formed in 1916) 7 surviving mem bers of the Order ou t of a total of 9; for the last 3 years these Order member (also member s of the Brigade) have organised a nnual coffee evenings co ntributing £ III to the Order.

York hire's Keighley Ambulance and Nur si ng Divisi on ha 13 members of the Order among past and present members.

London District's No. 130 (Laindon a nd West B(J sildon) Division (formed in 1930) has I I member of the Order on it s records. Cheshire's Altrincham Ambulance Divi ion (formed in 1902) has 14 surviving members of the Ord e r out of a total of 20; these include a father and son (Mr. H. and T. W Robert s), whose mother was a Serving Sister with a neighbouring division.

CADET UNI FORM

f rom W. E. St r eet, D ivisional Officer

What a pleasure it was to see a photograp h in the Mar ch Review of the cadet uniform of 50 years ago!

When I was the superintendent of ou r local cadet divisi on in 1948 , and indeed for a few years later, the cadets s till wore the original uniform style and were very often comp limented on its smart appearance, but with the disappearan ce of the Lanc e r shirt and the Glengarry head-dress I think the uniform has gradually deteriorated in appearance, until now the latest uniform is in.my humble opinion a monstrosity

Only a few weeks ago I was at a c(Jdet co mpetition where one team wore the latest style, and a lthough the cadets themselves were smart lads in appearance most of the other cadets when passing them raise·d their arm and said 'Heil Hitler', obviou!-> ly expre sing what they thought of the new rig.

The fact that most divisions will find diffi cu lty in raising the money to rig out their members if the division is of any §ize means that for some years cadet parades will look like Fred Carnos' army with their differ e nt style outfits, or the c(Jdets will stay away.

So whoever it concerns, please give second thoughts to this new uniform before it lS Officially adopted.

Exmoutlz, Delloll. III E. Street

fr o m S Tay l o r Divisional Superintendent

At a recent committee meeting of Woolston A & Cadet Division the new Dress Regulations for Ambul(Jnce Cadets as cont(Jined in Brig(Jde Ord e rs Mar c h 1973 (BO l572) were discussed (Jnd while it was agreed that improvements co uld be m(Jde to the boys uniform, it was not felt that the n ew suggestions accomplished this.

As you will appreciate, if thes e regulations are adopted it will involve m(Jny small cadet divi s ions in a large amount of cost. Southampto/l S. Tayl or OLD BAI LEY BOMBING

fro m B T B rown, B Se, M P S I was very impressed that a member of the public a St. John Ambulance man had found hi s way to the ca L1altle s and was able to help expertly with tem porary first aid.

'Members of tlw public instinctively come to LIS as chemists but first aid is not part of our training though through necessity most of us can deal with minor accidents.

'I would be gr(Jteful if anybody with training and co nfidence in first aid should come to my pharm(Jcy in emergency.' (That would of course be to treat the victims who would congregate there)

This was a compliment to those members of the Brig:.!d e who were present at till' Old Bailey bombing in L on don earlier thiS year, and came from a retail chemist who ow n s a shop in th:.!t vicinity in a letter to the Pharm(J ce utical Journal. Whether first-aiders should attend at the nearby che mist s (if ther e IS o ne)

READERS VIEWS

Readers' views and opinions, which should be sent to the Editor, although published are not necessarily endorsed by the Editor or the Order of St. John and Its Foundations Although readers may sign pllblished letters With a pen name, writers must supply their name and address to the editOr.

is open to doubt, since there would be a greater need at the actual scene. However it might possibly be of help to the pharmacist if he knew that there was a first-alder nearby whom he could call on should he come across something he couldn't handle on his own.

SuttO/7 Cold(ield Trallsporl Dip. B. T. Brow/I

CAD ET HO URS

from G. P Noyland, Divisional Superintendent

After reading the report of Cadet Sgt Phillip Green and hiS achievemen t of 1,000 dutle in 3 years (April Review), I must mention Cadet Fredrick Ja cques of my diVision, who IS 16 years old and achieved this in 16 months I Ie holds an adult first aid certificate, an adult nursing certificate, al-;o his advanced adult nur ing certificate.

Fred is the son of Corps Sgt Major J(J cques, of Sheffield Corp Sheffield No. I Cadet DiJ'isiol1 G. p. Voylulld

DIGNITY NO T LOS T from Rex Ingram, SRN, RCNT.

I shou ld like to enl(Jrge upon the comments of Mi. s Wilson's letter Replying To (March ReView).

First, her reply to 1. W. Harri s about taking or rather lay Instructors being exempted and loss of dlgnity in dOing so, my only comment is that if the hid Commander can do it, eve ryb ody (,;(In!

I am a State Regi stered Nurse and I teach a ll day long. I also instruct regularly at St. J ohn c asses and I think I could call myself a profesional (as opposed to a lay) Instructor I take my re-examination to satisfy myself tilat I am 'with it' and I can claim exemption on more than one count if I want to, so come on M. W., take your re-exam and 'practise what YOll preach'.

Secondly, to Mr. Moring and need for recognition as a professional ambulanceman, surely if hl' knows his Job and docs it well this is 11/1 that matters not going arollnd decor lted like Christmas tree In thi s area, the majority of the loca l a mbulan ce <;ervice were St. J o hn trained and wore ile S1. John badgl'. Why')

I ask. Because of its monetary <;ignificance? In a lo t of cases the answer is Ye s'. Be honest, Mr. Moring, I know thi S is not so In your case but does your ego really need a boost when you arc in Brigade uniform?

As I said aoovc, I am an SRN, and Grade \I Staff Officer so tha can wear Red Bars and till' State Badge, but I consider the badge superfluoLis and also a ilalard to patlenh. I have ot'cn called 'Doctor' by u Staff Officer (I Iyde Park) and instructed in the art of applYing a sp ra y to a patient's back by COl poral (N) (I-ast of I-:. ngl;lnd Show), so tiLat c,ln S,IY hoth extremes do not recognise the extra markings. Il owever, am not worried I am out as a ' Johnn y' to ilelp on a publiC duty or event.

To both, I would reply th<Jt it IS the job that matters, not the numb er of pips, etc, on the uniform. I have been viewed with disd(Jin by a fcmClle co ll eague (SRN) for lowering my professional dignity by silting on (J stretcher at a duty point at a grass track meeting with the boys (AIMs). Why? Because they were short of 'experienced' men. About ten minutes later, I was inside an upside-down mini, covered in oil and in peril of battery acid splashing my uniform Clnd, literCllly, under an unconscious fifteen stone female when we released her seat belt; but J did my job, [ taught by example my dignity was not lost and my uniform was soon cleaned. After a ll , when we joined the Brigade, we did agree to abide by the motto, didn't we?

Huntington Rex Ingram

WHEN THE NEW COMPETITION WAS NEW from John E. Dane, Vice Pre si dent, Croydon Centre carly in August 1956, [ received a letter from the Chief Officer of the Croydon Ambulance Service in which he said I shall be entering a team of two men of thlS Service in a competition between Ambulances Services comprising both theoretical and prclctical first aid, and [ wonder if you would be so kind as to give assistance in training the men for this kind of competition?'

When the lI1struction WaS complete it was suggested by the Chief Officer that a competItion should be held among his ambul(Jnce crews to gIve them practice, and select the best team to go forward to the competition proper.

Being the Competitions Officer of London District's South Western Area at the time, with teClms of experienced competition judges and a sistants available, St. J ohn colleagues (Jnd I were able (0 lay on rully staged tests covering the various sections set down in the rule of the competition.

I n due course thi came to the knowledge of the Training Officer of the Surrey Ambulance Service which covered a large p(Jrt of oLlr Area. He asked if he could ee the test papers for his guidance.

NEWSJA

HEADQUARTERS

After the compe titi on between the Ambulance Services had been held, he wrote to me from his Training School saying 'The tests held on Jun e 29 1957 were in three Sections (a) First Aid (b) General Rem oval (c) Highway Code, and nine authorities entered representative teams. Croydon Ambulance Service were the winners with 203\12 marks. Surrey second with 192 Yz marks. [ should like to take this opportunity of expressing my thanks for making available the various competition papers and training supplements. They proved most useful in the training periods held here just prior to the finals.'

Croydon John E. Dan e

COST OF HAN D BOOK

from C W. Potter, Div. Secretary

I am sure that most, if not all, Brigade members will agree that the cost of handbooks, particularly the First Aid Manual and the ursing Manual, is continually being accelerated by too frequent changing of editions. May r suggest to Headqu arters that they charge an economic price to people who are not members of the SL John Association fOr the purchase of handbooks, and keep the prIce stable for members.

Crook, Co. Durham.

IDEAS WANTED

from George Juke , Lay Instructor

C. W. Pott er

SJ A Kidderminster has small numbers in both adult nursing and ambulance divisions and have difficulty in maintaining an active interest among members.

J have many ideas for this problem, but would like to read in the Review how other divisions have overcome similar problems. Also I should be interested to read of schemes of work or detailed training programmes for ambulance, nursing and combined divisions.

K idderminster George Jukes

NEWS from SCOTLAND

Gl as gow

OWED E S D A Y A pril 18 the Prior and Chapter of the Priory of Scotland attended the Annual General Meeting of the Glasgow Branch of the Association.

The practice, begun a year or two ago, of bringing Chapter as a body to the regions to keep P riory in touch with the local associations and to inform members of activities and events on the wider scene is now a regular feature of the Order's life in Scotland. 1 do not think anyone would deny that it has been a success, making members of the associations aware of what is going on outside the regions to which they are attached and informing members of C h apter of the problems, anxieties and triumphs of the local branches. Every member of the Order or Association ought now to be assured that

WALES

Pembrokeshire

The Commissioner, Mr. E. E. Richards, presented his Annual Report to Council for 1972. The number of duty hours performed was 5,500 and 600 cases treated. Some of the highlights for the year were The Royal ational Eisteddfod; opening of Llysyfran Dam by Princess Margaret; inspection by Chief Commissioner for Wales, Col. J. R. L. T r aherne; the Annual Church Service at Slebech; visit by the 1I 0spitallers Club of W a es to the county. By kin d permission of the P resident, The H on. Richard Ph illips and Lady P resident, a garden party was arranged at Picton Castle. £176 was raised towards St. John Council funds.

The fo llowing cou r ses were held: Lay I nstructors Course, Visual Aids

E x hi b ition by the Chief Training Officer for Wa les, and Assessment Boards.

14 cadets attended the Celebration Camp at Llangorse.

Milford

We ll known Milford Haven Councillor an d coal-merchant Mr. Eddie Gough is the new P resident of the local St. J ohn Ambulance Division.

At his first pub ic appearance as Pr esiden t , M r. Gough assure d the St. J ohn officers and members: 1 am de l ighted by the honour and I am determined to be a 2 0

he participates in an institution which really cares for the feelings of the rank and file. Of co urse in a few years we may have to face a dan gero us , ituation in which the se visits become m e r e ly routine and then there might be arguments for making ome changes to prioral visi tat ions perha ps by in trod uc ing more solemn ceremonial and colour. But at the moment they are s till enough of a novelty to be fully appreciated by both sides and we should s tart to worry only when the time comes, in the meantime being grateful that prioral visitations have become so firmly established.

The Chapter learnt of Glasgow' achievements. The plan for s heltered housing is now fast becoming a reality, the Langside Residential Home, visited by

the Prior in the afternoon, is a model of it s kind, and the branch of the association has in ten years gained 600 member s. Warm tributes wer e paid to the Chairman, Mr. Herbert Green, who has presided over this success tory !l is participation in all activities and genero ity towards the Order provides an example t o all of us of how a knight shou ld behave.

Eas t Kilbrid e.

The lnve titme and Festival of St. John will be held this year for the first time in Ea s t Kilbride , where a new branch of the association has been formed. The cOIllmemoration service will take place in th e parish church and the General Assembly in Ba\lerup II all Clvic Centre.

proving it ca n be done by using the lads and lasses of my own quite large Division? The se were my thought s during th e Summer of 1971 My first ca d ets at Eton Wick Wind or soon earne d the nickname of Th e V I.P .'s' and, of course, Killay &. Di strict Division in Swansea qualified for that name in equal measure so the title of our big show was to be no problem l

The glrls and boys of Killay &. Di strict looked at me wide-eyed and incred ulous when I first told them th at a wonderful new adventure la y ahead one great night in the ncar future the cu rtain of Swansea's Patti Pavilion would rise on the first night of the first-ever big SJA Cadet Show What a rewarding challenge that was and from the word go what wonderful talent and enterprise emerged from lad s and Idsses who had never 1n their lives attempted anythi n g like this before.

Fortunately our dream was shared by fnends outside St. J ohn who kindly offered their <;pecialist help with the trallllng. A well-known local dancing teacher trained a couple of our youngest cadets o s t art the show with a tap-dance; a friend who had been a leading light in UJ1lon shows produced the sketches: a young man who presented the annual pantomime at the YMCA trained ollr chorus; dnd the musical director /acco mpanist of a well-known Valleys melle voice choir trained 14-yeal -ol d compere to end the WIth a Welsh song dnd selling of The Pr ayer. We dlso enlhted the help of a talented young organi<;t who travelled 20 miles each way from to help us at most of our and on the night of the show itself. To cap it all, we were fortunate enough to get a small orche,tra a wonderfully cncouraging ,1ddJtion!

SJA's only Brigade band in Wales at Newport, Mon - hal; 25 members, including 7 nursing cadets. Bandmaster D I Legge and Secretary K M Dunn are in cha rfje. Photo Q. R Start)

working president and not just a figurehead.'

The County Commissioner Mr. Einon Richard s presented certificates to th e adult members for s ucce ss in examinations and re-examinations.

The Superintendent of the Nur ing Division at Milford fo r many years, Mi ss May Gwilliam who has now retired, presented to the cadets a trophy in memory of the late Mr s. Margaret Garrett, who was for many years Hon. Secretary. The cup has been presented by members of the old Milford Haven Division for annual competition.

The Divisional Superintendent , Mr. W Ronnie King, thanked everyone who had supported and helped the Divi s ion and paid particular tribute to the Dlvisional

Surgeon, Dr. Gerald Leighton DaVIes, and Mrs. Davie s, for their active s upport. A buffet s upper was served during the very s u ccessful evening.

Th e V I.P. Show

The famous Scout Gang Sh ow gave u s the idea; and there the s imilarity ends. I was lucky enough to get ticket s for 'Meet the Gang' which was splendidly s taged by the Scouts of Swan sea and whilst watching it I had a sudden notion that the Sl. John Cadets s hould lilunch so mething like this but of course they mu s keep it original and put it under a completely different name. I t s hould be possible strange nobody has tried the idea b e fore in the Brigade come to th i nk of it what about

At fIrst, rehearsal... were not too much of a problem o n ce d week seemed often enough but as the date 01 our show drew ncarer and the appearance of our dforts seemed to me a long way short of the mark, rehearsah simply h,)d to be stepped up. This then meant that, on top of our normal weekly Brlg,lde meeting, etc, IllOst of Ollr cadeh were, for a short while, havlng to find at least two extra evelllngs per week for the show. lIe re I must express the utmost gr,ltitude for the understanding and co-operatIon of th e parents who somehow saw to it that school homework didn't suffer and Ollr cadeb were stili able to come to rehearsals. Of course, they were far from being angels on these and how I found the patience WIth them (I on l y lost my temper once!) still don't know!

r he dress reh earsa was nearly the fIni s h of me o call it ciuot IC would be to make the understatement of tlte yearl I went home sha tt ered, and convinced that the was monumental blunder

For myself the of the first night curtain was a moment of sheer terror. Yet somehow, miraculously, the audience loved everything they saw, and even the small things which did go wrong were so competently handled by our compere that he turned each into a highlight of the show (and even inSIsted upon retall1ing one such 'boob' to help the successive performances along!). I quite unashamedly felt like weeping from sheer relJef when 1 reached home that night. All I could keep saYl11g to myself over and over again was 'yoLl'lIe gOl a Sllccess 011 your hands '.

All that was in 1972 the year that gave birth to the St. John Cadet Shows, and as [ write we have just 'done it again'.

The 1973 V I.P. Show has been acclaimed by audlences as even beller than the first one. Unfortunately, however, the venture provll1g too much of a financial risk for one Dlvlslon. We want our show to be seen further afie ld and so this year we travelled out of Swansea to Cardiff and Pont ypndd, but we couldn't be there to sell our ticket and audlences were too mall to cover the heavy cosh of putting 60 chlldrcn on tage. Consequently, we view the future of V.J.P Shows with a ense of achievement tinged With sadne Pr oduc t ion-wi,e, Ktllay & Dlstrict Ambulance & \'ursing Cadet Division has shown S1. John Ambulance how a big song, dance and laughter sholl L'an be accomplished flnancially, it will be up to the Brigade throughout Britain to decide if the great adventure of V.I.P. Shows IS to become as Important to 1. J ohn Ambulance as the Gang Show u ndoubtedly are to the SCOllt Movem ent or whether the 11 w venture is to die for want of sllpport.

I will be delighted to hear from anyone who is willing to help develop the Idea of S1. J ohn V.I.P. Shows, and if

Some of the 60 cast of Wales' SJA V.I.P Show

Counties or Districts wIthl11 reasonable travelling distance of South Wales will ass ure us of our travelling costs, accommodation and ticket sale for our 60-strong show we wili start to prepare the 1974 V J.P Show with the promise that it will be at least as good as the first two!

We have illustrated programmes of the V I.P. Show available price lOp each. Write concerning the show or programmes to: Divisional Superintendent George Timpson, 36, Iaes-yr-Efail, Dunvant, Swansea.

Northern Ireland

SJA Belfast recently held a fashion show at the Girton Lodgc Hotel attended by the Lord and Lady and ove r 300 peoplc 'Belfast,' II rites d member, 'is not all bomb' and (hrown bricks.' (Below) R a th coo le ursing Cadet Catherine Cooper presenting a bouquet to the Lady Mayore s.

News from the Divisions

OBITUARY

('hl',hire. Died suddelliv Ull AprIl:! I Brigade 1llL!lllbL!J' for 30 ) e,m. Officer of the Order. I\ lr s. J M. 111\1\'1, for Illany

REVIEW CROSSWORD No.6 (73) Compiled by W. A. Potter

ACROSS :

1 R ooms for adjustment of lens focus for near vision. (13). 9. T hr ee-hea d ed muscle extending forearm. (7). 10. Dislocated thu m b is in element in gast r ic sedatives. (7). 13. Sore back for god in London. (4) 14. He takes 59 to make rounded margin of a n a uri cle. (5). IS. Warning to epileptic patient (4).18 Child just beginning to walk. (7). 19. An additional cent required to remove a too h. (7) 20. F ungus disease from my commanding officer and l ttle siste r. (7). 23. Hole in wrecked car gives water-borne infectious disease. (7) 25. R oman statesman and writer change coat. ( 4 ). 26. Disease caused by most minute organism m akes rival g o wi l d. (5). 27. Appeal to friend produces gem. (4). 30. Scent added to sodium in the freshly-formed state. (7). 32. Cutting tooth. (7). 33. Anaesthetic spray in dry Chile hotel. (5.8).

DOWN:

2. Cartilage of the l arynx. (7). 3. Fracture with associated wound. ( 4 ). 4. H is efforts help to keep the athlete fit. (5). 5. Surgically r emove foreign substances a n d damaged tissue from a wound. (7). 6. M ea ls to st udy efficiency of gastric digestion (4).7. Fruit used in f irst stage of n u trition. (3) . 8. Antibiotic used in treatment of tubercu osis. (12). 11 Appen d age of the soft palate. (5). 12. The chronic f orm is characterised by genera ised oed em a and cyanosis. (5 .7.). 16. Malar sign offever. (5). 17. Seat for discharge of the bowels. (5). 2 1 The tue skin is appearing after laceration (5). 22. The largest nerve. (7). 23. Twelve nerves emerging from the underside of the brain. (7). 24. Revea l ed to be without protection from the weather. (7) 28. Refute an allegation. (4).29. Mark of a wound. (4).31. Consumed a variety of tea. (3).

SOLUTION TO CROSSWORD No 5 (73)

ACROSS:

I. Premature baby; 9. Try.ps.in; 10. Eyeball; 12. Venous ; 13. Smarting; 16. I diot; 18. ALto; 19. Diet; 21. Chew 22. Ages; 23. A lgae; 24. Ensiform; 26. Trocar; 29. Tympana; 31. Arm bone; 32. In sensi bili ty.

DOWN:

2. R ay.o n ; 3. Mos.quiLo; 4. Tend; 5. Rheumatism; 6. B.l.ear; 7. Bo.a; 8 Stove-in chest; 11. Light - hearted; 14. Icing; 15. L. anger.hans; 17. [Jeus; 20. Lacrimal; 25. Flame; 27. Clout; 28. Ga r b; 30. M.an.

24

BOOKS

Food and Your H ea lth Disease and Health Systems of the Human Body

D is tribut ed b y Guild Sound a nd Vi io n Ltd £3.85 eac h

Each book contains twelve colour transparencies [or use with an overhead projector, teacher's notes and spirit masters for a c r ossword puzzle and three review quizzes, each book being d esigned as a short course in the subject. Although not tailored to St. John courses we thought this was a good presentation of a neat and compact package.

The tran parencies are very good, although to make full use of them would require an overhead projector, an item which is not freely available to most classes However by placing them against a rear illuminated surface, such as an X-ray viewing box, the pictures are clearly visible to a small group, and the eparate text is clear, being just right for 'at 1 glance' notes

The spirit masters provide excellent audience participation although they contain a number of 'Americanisms' which might not be fully understood in other countries. Each would give a considerable number of legible copies, even without pecial checks of pressure and spirit as might be done by a teacher in a hurry.

These handbooks co uld not replace the formal St. J ol1n course, but teachers might feel that selected transparencie could be used , although this would preclude a follow up with qui7 or crossword.

However, as an addition to a course or a a 'refresher' this system could be valuable and would be a useful addition to the armament of an instructor.

This presentation could also be most valuable in co untne with dietary deficiencies, as a well trained pers o n could substitute local vegetables etc, with ease; and also in thi country, e pecially at school level with the increase in immigrant population. The 'spirit master' may also perform a dual role in the teaching of b ngllsh.

There are some difference s between the American and English presentations particularly in the 'q uizzes' and crosswords, but these are minor and co uld easily be overcome by the instructor and we feel they should not be allowed to detra c t from the overall value.

In general we feel that these handbook should take their place in the mass of educational material, though the price would determine how high on the list. They are a useful aid to formal teaching though greater value could be obtained by selecting items from them rather than working through the books from cover to cover. We feel that their greatest value might be in lhe use as 'refresher' material or as a different presentation of subjects with which a group was already familiar.

ANSWER TO TEASER (see page 9)

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AT RANDOM

by Watkin W. Williams Deputy Commissioner-in-Chief

ONE OF T H E D SADV A TTACES of a monthly magazine is that a ll its news is bound to appear in print at least 3 or 4 weeks after tile events to which it relates, and some of it may be as much as seven weeks out of date. Be that as it may, my very fir t duty and priv i lege this month must be to express the immense joy shared by all members of S t. J ohn Ambu lance and most of all by the Cadets a nd those associated with them at the news of the engagement of our Royal Commandant -in -Ch ief of Ambu l ance and ursing Cadets. H er R oya l H ighness The P rincess Anne has a lready become, by her direct personal invo lvement as a membe r of the 'St. J ohn family', a pecially beloved person to all other members of that family, and her own joy is one which we take a special delight in being allowed to hare. To Mr. Mark P hillips we offer our warmest congratulations, and to H er Royal Highness and her fia nce we would like to expre '> our most loyal and affectionate good wishes for a life of fulfilment, joy, prosperity and fulne s of days.

Honours

Another joy that we all share at thi time. and will most wish to expre s, i in the fact that no Ie than four member of the St. J ohn Ambur"ance Brigade have been honoured by Her on her Official Birthday three of them in connection with their outstanding ervices at the time of the reception 3nd r esettlement of Uganda Asians la t autumn.

Mr. Derek Fenton, Deputy Commissioner of the London (Prince of Wales's) District, is already well known far beyond the confines of L ondon District for his untiring devotion to the organisJtion of first aid and other public dutie both routine dutie s and those undertaken in time of sudden emergency by St. John Ambulance in the metropolitan area. Throughout the Uganda ASIan emergency he remained on call hours a day, working in the close t co-operation with the Uganda sian Re ettlement Board's representative at Heathrow and with our colleague in the Red Cross and the \VRVS. H e arranged meals at Heathrow provided long-distance e cort from the airport to reception centres, and himself pent every possible moment out s ide his working hour personally directing the efforts of our members at the :Jirport. I n addition, he provided teams from London to relieve the hard-pressed Fssex and Hertfordshire contingent at Stansted airport b) taking over from them on two day each week: and at the request of the Board he arranged for the vetting of private accommodation offered to Asians in the London area. His a\Vard of the \Vill give special pride jo) to all those \Vho 0 loyally co-operated \Vith him.

T h e t BE ha a1 0 been awarded to 1\ 1r. A. J. Burton. Count\ S t afr Officer for Warwickshire, \Vho cro\Vned 36 year' crvice i;l the Brigade (mainly in connection with large- cale public dutle and ervices to the crippled) by taking charge of 300 1. John ( COil fllll/ed 011 page I J )

within the United Kingd om or to the Continent, and can usually be in the air and on their way within an hour after the Control Centre has received a call for help.

As Senior Control ler, Wing Commander Drummond's first tasks were to organise the functions of the Control Centre, estab li sh a procedure with appropriate documentation which would ensure the quickest and most efficient response in an emergency, and to train the volunteer contro ll ers in its use. It was hoped, originally, to man the Control Centre at Epping for 24 hours a day throughou the year, but this proved to be impossible, in that almost all controllers had other responsibilities as profes ional men, business executives, housewives, pollce officers and the like.

The installation of a GPO answer-phone to receive calls proved to be the solution to the problem, and with a round-theclock duty roster for controllers, it is the Wing's understandable pride that they have never fJiled to answer a call on their ervices.

alarm but an increasingly familiar signal for immediate action, complete cooperation and service of the highest order. There was an instance when a Germa n airport was taken com pletely by surprise and the language problem was not easy, bu t once the message was driven home in a mutually accepted mixture of English, French and third-form German, the celebrated Teutonic thoroughness came to the fore and the Wing pilot was accorded VIP treatment in landing, pickup and take-off. On another occasion involving one of the rare day-time flights, the traffic controller at an English airfield which closes at sunset almost begged the Wing to let him in on the act at nighttime. He had heard all about the operations of the Air Wing and felt very much left out in the cold because he had not yet had a night calli

taxied up and down the unlighted runway with his landing light on to make sure that there were no obstructions, then, keeping his nosewheel on the centre white line, took off for Belfast. IJalf-way across the Iri sh Sea, Belfast airport informed him that they had suddenly becom e fog-bound, but a famous ship-building company with a private airfield a few miles to the east, which was still clear, cheerfully turned out their staff, opened up and a safe arrival completed a rather excitmg and very important mission.

A MEDICAL EMERGENCY DELIVERY: NO OTHER SERVICES AR E

AVAILABLE : THE BRIGADE'S NE W AIR WING IS THE ANSWER

At the same time the Department of Health and Social Security, very much alive to the problem, had evolved an organisation for co ll atin g the information necessary on the many sufferers throughout the country awaiting a kidney transplant operation. Thi s meant they were able to match the characteristics of kidneys, as they became availa ble, to those of a particular recipient. The Department gratefull y accepted our embryo Air Wing to complement the arrangements they were making for the movement of kidneys throughout the country, and towards the end of 1971, following di scussions between the Dep artment of He alth, Brigade members and a few volunte e r private pilots, it was agreed that such a serv ce co uld be esta blished under the ae gis of the St. John Ambulance Brigade On February 2 1972 the Air Wing was officially inaugurated at the Epping Control Centre, generously provided at the St. Margaret's Hospital, Essex, by the Ho spital Management Committee.

In the beginning, pilots were few in number and ground controllers, though enthusia s ti c, l acke d experience in aeronautical matters.

The ai r transport si de of the Wing 's organisation was very quickly put on a sou nd operational basis by S/Ldr. Pattison with the establishment of pilot groups at Booker Air Park an d Elstree.

THE ST. JOHN AMBULANCE Air Wing was formed some 18 months ago at Epping, Essex, to provide a volunteer air service for the rapid transport of organs, drugs, blood supplies and patient s in emergencies when other means are not available. The function of the Air Wing is to assist by any possible means in lifesaving or emergency missions in the United Kingdom and abroad, within the scope and ideals of St John Ambulance and the Order of St. John The Air Wing's origin was derived from two main sources. One was the interest of the Epping St. Margaret's Division of the Brigade, under its President , Mr. P G. Bowen (Hospital Secretary) and its D ivisional Superintendent Mr. R. A- Peedle , in the possible uses of light aircraft in ambulance work and in the training of Air Attendants. The other was the enquiry initlated by a major London hospital into a means of rapidly transporting kidneys required for transplant operations. Once a kidney becomes available for transplanting from donor to recipient it has a limited life outside the body if it is to function efficiently after transplanting. There may be hundreds of miles separating the donating and receiving centres, whether at home or abroad. and road, rail, sea or air scheduled servIces do not always cOIncide with the time available; so it became obvious that the provision of a speedy transport service, which could function at short notice, by day or night , would go a 2 long way in ensuring a minimum loss of time in cases of urgency.

His continued efforts reinforced by the strong fellowship which exist among all who fly, resulted in a steadily lI1creJsing flow of vo lunt eers for this humanitarian work, so that at the end of the first year of operations, the Air Wing could call on the willing service of 95 qualified and experienced pilots, all of whom had satisfied the very high standard of proficiency set by the Squadron Leader.

These pilots own, or have available to them, a total of 62 aircraft, of which 23 a r e twin-engined, and many arc eqUipped to full airways standard in respect of radi o and navigational aids. Cruising speeds vary from about 110 mph in the case of the smaller 'singles' to over 200 mph for the 'twins'. The Wing reimburses the pilots' expenses for fuel, oil and landing fees, but time and expertise are freely given by a ll who fly these mercy missions.

The majority of the pIlots are formed into groups, eaeh administered by a Group Co-ordinator appointed by Squadron Leader Patti son, at various airports throughout the country, in additlOn to Booker and Elstree already mentioned. These groups are ocated at Dundee, Glasgow, Newcastle, Teeside, Leed / Bradford, Manchester, Liverpool and Cardiff. Additional groups are lik e ly to be set up at Sheffield and Birmingham, and, in add ition there are ' un attached' all over the United Kingdom operating from smaller airfie ld s and private landing strips. Pilo ts and planes are available at any hour of the day or night for flights

Tn the period between February 20 1972 Jnd May 13 1973, the Air Wing c<lffled out 53 successful mission in the transport of kidneys, drugs and patients, and new nearly miles; pilots and 'stood by' on 38 occasions before the request for assistance wa cancelled. Fifteen of the flights were overseas to the Continent or to Ireland (France, Denmark, Germany, Dublin, Belfast) and over forty were at night. Flight llmes vary, obviously, according to the di lance involved and the speed of the aircraft doing the job. For example a kid ne y was delivered in Glasgow from London only 21/2 hours from the first call for assi tance, but a miSSIOn involving a flight from Essex to the South of France and back to Oxfordshire with a patient took almost 18 hours from first call to completion.

The dedication of Air Wing members (who are accorded the status of Auxiliaries of St. John) whether flying, generally at night and often in bad weather, or itting for hours on end in the ontrol Centre or at home, telephoning, checklllg. cajoling, advising or simply waiting, would not achieve its full purpose without the ready co-operation of airfield authorities and their Air Traffic Controllers.

The number of airfield open ilt all times, day or night, is limited and more often than not, airfields have to be opened specially for the arrival or depart ure of Air Wing aircraft. Civil airports, RAF airfields, Royal avy Air Station and the United States Air Force field in the UK all give full co-operation.

The Duty Contro ll er's announcement over the telephone, 'Thi is the St. John Ambulance Air Wing we have an emergency medical flight', to any of the e i no longer an occasion for surprise or

The priority accorded to aircraft of the Wing on emergency mlSSJOns is very high indeed; the tower supervisor at an mternational airport has more than once 'stacked' jet air liners and kept them in the air so that a small St. John plane could make a ljuick landing or scud across the control zone on a mercy flight; it has been known for the runway in use to be specially changed to cut down on taxi-ing time in the interests of a quicker pick-up and take-off. Although the Wing is of such recent origin, a hi tory of incidents and anecdotes is already beginning to build up.

A pilot answered a call one mght, dashed to his airfield, found it dark and de erted for some unknown reason, and fog beginning to form. He pushed his aeroplane out of the hangar himself,

On yet another occasion, two pilots (one aircraft) landed at Paris-Orly just as the fog closed in on them. A ghostly French hand appeared, grabbed the precious parcel and immediately disappeared, leaving them alone and abandoned in the middle of a huge expanse of tarmac. They crept around, found a parking space, locked up the aircraft, managed to find a couple of beds in town, but had a terrible job to finn their 'plane again the next morning! Such can be nying with the SJ Wing There are pilots still awaiting their first call to fly for the Wing and some controllers who have not had the thrill of 'running a mission' during their spell on duty, but enthusiasm remains unabated and to have flown a mission or controlled one from the ground is now an accepted status symbol among members. 10st, though not all, of the work so far has been in the transport of kidneys for transplant operations, but there are now under consideration other possible uses of this unique service

(Continued on next page)

An Air Wing flight from the South of Fr ance to Stoke Mandeville last September - with a 20·year· old tetraplegic casualty. The cost of this flight was paid for by a mother of four after hearing about this mercy mission on Radio London. (Photo: Evening Mail, Slough)

Mercy Flights

TO CARDIFF AND BELFAST

by Ron Mogg

NOEL KNIGHT, a technical representative, was asleep at his home in Berk shire when the phone rang at five minute to one on the night after ew Ye ar's day 1973.

H is wife Elizabeth went to answer the phone as Noel rolled out of bed an d started to dress for he knew the ca ll could be for a Mercy Missi o n - to fly urgently nee d ed plasma, medical s upplies or kidneys for transplant oel , wh o shares the ownership of a Beechbaron twinengined aircraft with a friend, is a member of the St. John Ambul ance Air Wing.

He is one of 95 pilots who have 62 aircraft at their disposal at various places in the UK. They are available for medi ca l mercy missions at any time they are required, and they cover the wh o le of Europe

'That night call was a typical instance of the work of the wing ,' said oel. 'I knew Belfast wa s the ultimate d estination, but I told Elizabeth that it was Dublin because I thought she might be worried about me flying to Belfast.

' It was a foggy night, with visibility at less than 25 yards. It took me ten minutes longer than usual to drive to Wycombe air p a rk , but managed to get a take-off time of 01.55.

'1 then flew to Man s ton where the police and St. John Ambulance had arranged for kidney s to be picked up. In spite of the fog and a rather unpleasant take-off I landed at Manston at 02 30

'At 03.25 still flying through eight -eights clouds I took off for Rhoose Airport, Cardiff, for the first delivery of kidneys.

'I landed there at 3.40 flying on

National First Aid Competition

instruments the whole way. [t took only five minutes to hand over the parcel for Cardiff, and then was on my way to Belfast.

'{ arrived there at 05.30, refuelled, and took off again at 06.30.'

Be cause of the thick fog oel was unable to get into his home airfIeld, Wy co mbe Park and had to divert to Birmingh am. He eventually arrived at hi base. 'It is the first time I had been late for work in the ten years,' co mmented oel. He did not trouble to mention at work that due to his efforts that night he had done much towards saving two lives.

'We get repaid running costs and out of pocket expenses from the Air Wing,' said Noel.

St. John Ambulance Air Wing pilots make trips all over Europe and into Scandinavia - and the mercy mission calls always come late at night, out of scheduled flying hours.

RESERVES

ST JOHN TAKES TO THE AI R

NEWCASTLE

TO DENMARK

by Trevor Atkinson (of The Journal, Newcastle-upon- Tvne)

TilEY said it would never happen.

But for J ol1n Lewis :Jnd Alan Summers, their dramatic middle-of-' henight mercy dash across four countries was very real.

With the throttles of their 190 mph Piper TWln Commanche aircraft wide open they were suddenly in the middle of a tense race agall1st the clock to fly a kidney from Britain 850 miles across Il oliand and Germany to Denmark.

J ohn, of Gosforth, 1S a 37-year-old managIng director, Alan IS a quantIty surveyor.

They arc auxiliary pJ!ots of the St. John Ambulance Air Wing, two of a handful of orth-I:.a t professional and business people who are on permanent 24-hour stand-by to ferry vital organs by air for operations.

Not all the mercy nights have a happy ending, and sometimes after a warning call has been given and all preparatIons made the mission IS cancelled for a number of reasom, but don't concern the piloh They are there to fly, if needed.

Specd IS VItal 111 all missions because the life of a kidney, [or instance, is limited to between ten and twelve hours once it is removed from the donor.

There are a number of centres in the United Kingdom and Europe where kidney transplant operatlons are undertaken, and these can be effected only after a comprehensive cross matching of the characteristics of donor and reciplent. word with wife Elizabeth: 'It does mean we have to be on call most nights, but I think it is worth it. oel is helping to do a ternfic Job, and what's more he even rinds time to vi it sp:lslic children regularly at a local hospital.'

/\. few days before in the lounge bar of the ewcusLie Aero Club, they had Jokingly remarked over a beer together thaI an international mercy mission to Denmark would never come their way.

But it did. Without warning. At 5.30 pm lhe next

A computer al the atlOnal Organ t\[atchll1g and DlstnbutlOn ServIce at Bri tal had come up with a kidney donor In Coventry and a suitable rec1pient in Denmark..

The long-distance telephone call from the London St. John AIr WJl1g co-ordinator tarted it all.

Could John Oy a kIdney from Coventry to Denmark in a hurry?

The destInation: Tirstrllp, a milit:HY airfield in orthern Denmark.

To John, it was an unknown place in

t-he middle of nowhere which was going to involve a tricky night landing. Obviously a job for two men.

A telephone ca ll to the control tower at Newcastle Airport located Alan, just back from a business trip. Could he go? Affirmative.

Time. 5.45 pm. Another telephone call to St. John in Lond on to confirm the mission.

John and Alan pack overnight bags, turkey and tomato sandwiches and a flask of coffee, and race to the airport in Alan's Jaguar, clutching an assortment of maps and charts.

Meanwhile, the London co-ordinator has given the 'go' to hospitals in Coventry and Denmark. Both airports in the two countries are warned to stay open.

Airport crash crews, refuellers and ground controllers stay on duty.

By the time J ohn and Alan reach ewcastle Airport their aircraft is on the apron, refuelled and cleared for take-off.

6.15 pm and the runway recedes into the gathering gloom. 'Ambulance priority flight' IS on its way. The airways are cleared. As Alan puts it 'they unrolled the red carpet for us.'

Only then did they realise that in the hurry they'd left their passports behind o time to worry about that now.

Birmingham Rad ar is already guiding them into Coventry before fog blankets the airfield.

7.30 pm. Before the propellers have stopped turning, a box marked 'Kidney for transplant' is loaded into the cargo hold.

By 8 pm. Coventry is a hazy memory. Four-and-a-half hours away i Denmark.

Through the darkness they drone, across the English countryside and over the sea. The letherlaJ).a-s- and Germany slip by.

By the time fhe Copenhagen radio beacon is picked up, urgeons in the

Visiting Leicester

Danish hospital are starting the operation.

Fifteen minutes after midnight the Commanche taxis to a stop at Tir strup.

An ambulance is on the tarmac. The kidney is transferred and within what seems only seconds, everyone has dashed off leaving John and Alan 'standing like a couple of lemons.'

Said John: Jt was a bit of an anticlimax really after we'd been all tensed up on the journey but that's the way it goes.'

An airport meal, washed down with lemonade, was weanly consumed, before they were taken 25 miles by taxi to the nearest hotel.

'We just crashed into bed,' said Alan. 'Quite honestly we had no idea where we were, but boy, did we sleep.'

At lOam they started the return flight home direct - an uneventful trip - and set foot again on the apron at ewcastle Airport at 1.30 pm. Their mission had used up 19Ya hours and spanned around 1,300 miles.

Back in the lounge bar of the aero club, a friend inquires of Alan: Hello where are you off to?' , owhere,' says Alan, 'we just got back.' John, meanwhile, is talking about the volunteer work they do. This mission to Denm ark has been their second and by far their longest.

'We're fairly proficient pilots and we've got an aircraft that is capable of doing this kind of thing so we felt we could contribute so mething ,' he said. Alan comments: We don't get any details of where the kidney is going to or who it has co me from. We don't at the moment even know if our mission was a success. r hope so though, r really hope so.'

And for the moment it's home for the pair of them, back to pick up the threads of ordinary day-to-day living, until the telephone rings again

Noel Knight - one of the Air Wing's 95 volunteer pilots

Fracture or Sprain?

HOW THE INJURY OCCURRED IS ALL IMPORTANT by R . A . Elson , MB , FRCS .

WHY IS IT that the same accident can produce a fracture in one patient or a torn or prained ligament in another?

This is a most complex question , for if someone fell from a known height and landed sufficiently heavily on one inturned foot , because of irregular ground, so that his ankle twisted, it would be almost impossible to predict whether a ligament injury or a fracture would be produced, even by using the most advanced methods of investigation. Assuming that the height , and therefore the force of the stress, were sufficient, and the foot rolled onto its outer side, the inju r ies shown in F ig. 1 might occur -

singly or in some combination, and other variations are possible.

An ankle injury is a useful examrle for study because this joint is such a complicated system of bones and ligaments: the same principles apply howev er throughout the musculo-skeletal system. You can see that from one type of accident to a part, numerous differ ent injuries are possible. Some combinations of these are more common however, and certain generalisa tio ns and pred ictio ns can be made.

For example, a rupture of the outer ligament of the ankle joint is unlikely to be accompanied by a fracture of the

l a tera I malleol US, beca USC 0 nce the ligament has given way the cnergy of the force will have spent itself and the bone will not be exposed to any further converse ly , shou ld the bone fracture, the ligament will be no longer strall1ed. What det ermi nes which hould brenk first?

There are several factors: Fir stly, there is a property of (in this case bones and ligaments) called strain-rate sensitiVity, a technical term [or a phenomenon ea iJy understood from the day-to-day situation of breaking an egg. If you pres lowly on to the surface of the egg with a spoon, you can increase the force considerably without breakage;

on the other hand, if you tap the egg with the spoon, perhars exerting apparently much less force, it will crack. This difference i due to the fact that in the second instance, the force was applied ra{Jidl,1' Whenever force is exerted on a body (in this case the egg) it deforms lightly It is Jid to be strained I f this deform:Jtion is rapid, the shell does not seem to h:Jve time to disperse the energy of the force and :J fracture occurs H ad the force heen applied slowly, as in our first eX:lmple, the strain would also have occurred slow l y and the egg would have been able to withstand a greater force.

The same ort of situation applie to the ankle except that the materials and 'itructures are vastly more complicated. In general, bones withstund slowly applied forces welL (by slowly, we mean the sort of speed experienced in walking, running, Jumping or kicking th e speed of applicatIOn of the forces which occur in accidents clre much more rapid, esrecially in high velocity road aCCidents.)

Ligaments, on the other hand, stretcll and finally rupture if slowlY-<lpplied forces become too great: they eem to be Lible to with tand more rapidly applied forces however. 'When a force is applied to the outer side of the ankle, as occurs when the foot turns over, If it is sudden, a fracture is more likely, whereas if it is slower to develop, perhap' the ligament will rupture in tead.

The foregoing describes how speed of application of a force is significant in deciding what sort of injury will occur to a rart: but there 1 another way in which it determines the nature of this injury and relates to how much time and warning the muscles of the part are given for them to react in an effort to protect it. I n the example of the twisted ankle, if the accident is rapid, as in a sudden athletic situatlon in which the whole body weight is thrown on to the inturned foot without warning, there unlikely to be time for

any protective mechanism to be put into ope ration ; in less su dd en circumstances, if the twist took place during ordinary walking, as the ligam ent becomes dangerously strained the body reaction has time to develop and this results in rapidly transferring the body weight on to the other foot; the person often appears to stumble as he makes a quick movement with the other leg in order to get it into a suitab Je postion to receive the body weight. Sometimes, the manoeuvre causes the subject to fall and perhaps injure himself in some other way.

Lastly, there is the age factor. As we grow older, the different strengths of our tissues change, and the rapidity with which we can react to protect ourselves also diminishes. A good example of the variation due to age and its effect on the results of the same sort of mishap is that seen in the quadriceps mechanism (Fig. 2). This term applles to the whole connectIOn between the enormously powerful quadriceps muscle and the tibia by means of its thick quadriceps tendon inserted into the top of the patella, the patella itself, and its patellar tendon which connects the lower surface of the knee cap to the tibia. By this rather eom plica ted linkage, the q uadrice ps is able to straighten the knee.

In old people, the bone of the patella becomes weaker and a stumble, in which

the person has to suddenly take full weight on the leg contracting the quadriceps vigorously in order to prevent the knee from bending, results in a severe strain to the patella, sufficient, in the elderly patient, to fracture it; it snaps cleanly across and the knee consequen tly buckles, allowll1g the subject to fall to the ground. In a young subject, this injury would be less likely, but a powerful contraction of the muscle plus an unexpected force across the knee, as can occur so easily in sport injuries, can cause the quadriceps tendon to pull-off from the top of the knee cap. Again, in children, it is possible to partIally avulse the patella tendon from the top of the tibia where there is a growth centre. (These differing injuries are not related to direct blows to the front of the knee, where different types of fractures or ruptures occur.)

It is hoped that, without becoming too technicaL the first-aider will haVe gained some idea of the factors which cause d ifferent injuries from what might appear to be the same type of accident. What is important from a practical point of view is that a detailed history of how the injury occurred may help the doctor to make a complete diagnosis; as is so frequently the case, the first-aider may be in the best position to furnish such useful information.

CALLING PROFESSIONAL NURSES

THE 15th Quadrennial Congress of the lnt ernational Council of urses wa held ll1 Mexico City in J',[ay and I had the privilege of attending. The circ ular Palace of Sport with its pineapple shaped dome, familiar to all who watched tile Mexico Olympics, was used for the sessions. The tadium hold about 25,000 people, so 10,000 nurses only half filled it. To overcome this, the platform was placed in the centre of the arena and we used a semi-circle of stands.

The working ses ions were of great intere t and I am sure you will read details of the change in the on titution in the nur ing pres. The Plenary Sessions devoted to the theme 'Nurses and lIr ing', were most timulating. All delegate were given the opportunity of attending two special interest ses ions, small groups which gave opportul11ty for discus ion. I selected Intern ational Cooperation in ur ing Education' and ' Partners for the Health Team: Patient s, Familie s and Students'. It was interesting to hear that many countries were directing their thoughts and idea in the same direction as ours: ie, that education mu t prepare leaners for total health care and

the accent must be first on preventative medicine and community health care, so as to provide a background for hospital care and a better understanding of the patients' and relatives' needs

The closing ceremony of the congress was most impressive: six new members were admitted, bringing the total member countries to eighty. Dorothy Cornelius (US ) was elected as the new President and in handing over, Margaret Kruse, the retiring Pre ident gave the watchword 'Flexibility' for the next quadrennium. Docia Ki eih, SR ( Ghana) was elected Fir t Vice-President a great honour not only to Ghana but to St. John, a s Kis eih is Prin cipal Superintendent ( ) for St. John in Ghana and we send her our warmest congratulations.

Following the congre the Briti sh nm es spent a few days holiday eIther in r-.lexico City, Acapulco or lerida before returning home. I cho e the latter in order to ee the Aztec and Maya civilization: before flying on to San Francisco for a coast to coast tour of the southern USA.

Rosemary Bailey ehie/Nursing Officer

7

Fig. 2 The quadriceps and its insertion through the patella

TO GUERNSEY

The Chief Commander Sir William Pike flew to Guernsey for a busy day in early May to open the new headquarters of the orthern Division at Le Gigands.

During his visit Sir William m a de a trip on the Brigade's ambulance launch Flying Christina 2, met all ranks of SJA on the island, visited the Rohais headquarters, and presented a silver salver to the ursing Cadet Division, which has won the ational Finals competition for 3 successive years. The island ' s ambulance cadet presented Sir William with a traditional Guernsey milk can in miniature, of course.

TIMELY

A letter from a Mr. Caine, of Walton-on-Thames, says:

After completing a first aid course on April 19 and receiving my certificate, the instructor said ' I hope you don't have to use what you've been taught , but you can never tell when first aid is wanted.' The very next day while taking my family to the coast by car, we came upon a very bad accident. I was one of the first on the scene. The car had overturned several times four of the passengers were thrown out and one was still inside. The confidence I gained at the course is what helped me give first aid to three of the injured.

Of the five people - one h ad a fractured spine, ankle and multiple cuts; one had very bad head injuries and mUltiple cuts; one had a suspected fractured wrist and very bad shock; and the other two were not in my care but received a broken leg, and broken arm/collarbone. The three I attended had landed on barbed wire in a ditch.

1 am convinced that if I had not been on the St. John Ambulance course I would not have been able to assist these injured people.

AROUND and ABOUT

WHAT'S GOING ON IN TH E WORLD OF ST JOH N

SJA / JUH

London Di s tri ct Deputy Commissioner

Derek Fenton (just awarded the MBE) and his wife recently visited many groups of the Johanniter Unfall Hilf e in South ern Germany, including Stuttgart, Ravensburg , Friedrich sc ha fen, Memmingen, Munich , Nuremberg, Wurzburg and Mannheim.

Contact was renewed with many J UH members who have visited Lond on during the last 15 years, or who were a t ast year's joint J UH / SJA training camp on the Isle of Sylt.

Mr. Fenton was very impressed with the keenness a nd enthusiasm of m embers and the progress being made, particularly in the field of social services, from whi ch much of the JUH fund s derive. The exchange of idea s is highly beneficial to both organisations.

During May members from Paddington , Willesden and Ealing visited Mannheim and were on duty at the annual May Market. Another group from Richmond were guests of the JUH ill Cologne Bonn a nd Hanover.

HELP

Bromborough, Eastham and Port Sunlight Combined Division , which is celebra ting

EXAMINER FLIES IN

APPOINT

ME N T S

The Order : Major HamI sh Forbes, MBE, MC, to Secretary of the Order.

Priory for Wales: Bailiff of St. Davids, Sir Cennydd Traherne, KG , TD, JP , MA, LLD. Chancellor, Sir Michael Duff Bt. Jr

Vice-Chancellor, E. W. Meurig

William s, MCh, FR S, MB, BSc.

Headquarter: Lady Rosula Glyn has now joined Cadet<; Dept. Mr. John Lo ckett, MIPR, has been appointed Publi c Relations Officer.

St. A.A.A. (Scotland): Mr. Strachan's appointment IS now

Dire ctor General and Secret3ry

Birmingham : Mr George Blackbarrow, OBE , to Chairman t. ] ohn CounciL

Lanca hire: Dr. L. A. Michael to Area ('omm.

Nottingham hire : Mr. R. Haw orth to Area Comm.

North Riding: Lt. Col. G. T M. Scr ope, OBE t o Dep . Comm.

Somer et: Mr. G. W. ailor to Area Commissioner , vice Major Greener now Commissioner, Bristol.

its Golden Jubil ee this year WIth a CIVIC reception and many other ;lc tIvll1 es, badly needs a new HQ They've got the land and planning permIssion now they need the money for the building. To help in this direction the Green Shield TT<ltlJng Stamp Company has agreed to exchange comp ete book s of Green Shield stamps for them for cash, so the Division is asking readers if they can pare a full book of these s tamp s to help their building fund. Books sho uld be sent to: Mr. W. G. Bowman Appeal Treasurer, 32 Fairway South , Brombor ough, Wirrul.

MAKING FI LMS

The following is fro m Mr. A. V esse l o, deputy c hairman of the Vi ual Aids Committee:

Fr e d Brown is an ent hu sias ti c first aider. He is ;llso an enthUSIast with an 8mm m o vie ca m e ra. Th e bright id ea has occurred to him that he might combine the two e nthu sias m s a nd make films about first aid.

BY THE EDITOR

Why not? An excellent thought provided he bears one or two fundamental point in mind.

Up to now, Fred's film-making has concentrated on varied scenes of the family 111 nction at home or abroad. Great [un, and worth the expense invo lv ed, and, incidentally giving him some useful basic experience in handling a camera and people roaming about in front of it. He also ha s some eye to technical quality

But in general he still hasn't got very far away from the moving s napshot; andlet 's face it when it comes to editing and continuity his ideas are rudimentary. Edlling is largely a matter of 'cutting out the bad bIts', and continuity IS running the scenes head to tail as they occurred.

Making even the simplest film on first aid demands a more systematic JPproach. Fust, Fred has to choose a subject. (First md is not ;l subject, in this sense: it is a field from which individual subjects may be drawn.) 0 deep thought is necessary to film, say, a demonstration of how to deal with a particular accident or an exercise for future study.

Having chosen 11IS subject, filming needs planning. He has to think what is likely to happen and where he must be with his camera at each t3ge 0 as to get the most revealing viewpoint. If a demon tration IS to be filmed he will

FROM N.Z . TO CUMB

soon realise that the only proper way to do it is to work out a scenario with the first-aid personnel concerned, breaking it down into shots and being prepared to tnke shots several times if he is at all unsure of the result. Of course, if he can find a fellow-enthusiast with anothe r camera, and they can learn to work together, that will be a real bonus. Then they can station themselves in different positions (changing as necessary) and inter-cut their results. But this means very careful organisation.

If planning and script-work are good, editing should not be too difficult. Effective timing (not too long, not too short) and seeing that one shot leads

logically mto another from a specific beginning to a specific end - these are the basic pnnciples. What about filming action which Fred can't cont rol ? This can be complicated and Fred had better resign himself to some initial failures. But here, too, planning is the essence. What I would suggest is to start, not with a full-scale exercise, bu t wi th some practice-work by an individual team. A re cord of something of this kind, really well done, can be very illuminating; among other things, it lets people see their own mistakes, with an effect that mere description can never achieve.

So far I have only mentioned a silent

READY

'Steady, lads remember les 011S.

First things first panic lessen.

Is there a ny further da nger?

Can you phone the ambul:ll1ce, stranger?'

We knew this was to be Our Day,

But not in this realistic way.

While out to prove we were the best, J ust didn't expect this kind of test.

Hysterically, a girl was shouting, 'Mum and Dad were on the outing.'

Momen ts ber ore, every t hi ng righ t, But now it's a horrific sight.

IN MALTA

A group of 24 people from St. Helens Corps (Lancs) and ed by Area Surgeon D G. J. Fairhurst on a recent visit to St. John headquarters, Valletta

film, perhaps with sub-titles. If Fred can on occasion afford a sound-commentary to his films this obviously extends his possibilities; but then he must plan from the word go with film sequences to cover his Ideally, he works out his script in advance (he will have done a sum m ary treatment first) with the short list on one side and the accompanying commentary on the other, timed precisely to match one another. Where this is not practical, and the detailed commentary has to be constructed afterwards, precise matching is still just as necessa ry. And one word of advice to Fred - don't overdo the commentary. A little talk goes a long way. If Fred or any of his cronies would like to discuss film-making principles or problems with somebody at HQ, Philip Adams, Secretary of the Visual Aids Committee, says he will be only too glad to hear from ihem. Scripts for comment will be welcome, and any finished films which have more than local relevance will be seriously considered for copying, so that they can have wider distribution.

INFLATION

Divisional Superintendent Miss Edith Shepherd's advertisement of a SJ A Home Nursing course in a local London, SW 1, newspaper quoted the fee as £ 100 plus manual. She ruefully told me she had no replies to the advertisement for the one pound course.

THE

CRUNCH

To Exeter we made our way, One Springtime morn in early May, Peaceful, pastoral, postcard scene, No discordance, all serene. Our little car just hummed away, T'was Regional First-Aid Finals Day. We'd practised hard, studied keen, Now, results would soon be seen.

Suddenly, without warning, On this peaceful May-day morning, Searing sounds of metal clash.

'Look-out, Bill, there's been a crash.'

Screeching brakes, high-pitched groaning, Then distinctive plaintive moaning.

Shattering noise of flying glass, People lying on the grass.

'Don't crowd around please, and don't fear, We'll get them safely out of here.'

Reassuring those with hock,

'Take deep breaths it's just a knock.

'This one's breathing's apparently gone

Give her respiration, Ron.

Try to stop that bleeding, mate, The other one will have to wait.

['11 examine by that Rover, And turn those two unconscious over. Don't forget that driver, trapped, I'm sure his chest needs to be stra pped.'

Back in the car, when the worst was over, 'Those two trapped set us a poser.

Thank God we've got ResLiscie Anne , Ron's Kiss of Life helped save young Jan. Hysteria did cause a fuss, But calm enough when helping us.'

So we talked of the 'ins and out'

Of the First Aid we had carried out.

Later, when in the competition, Everything slotted into position.

We saw the reasons, as never before , For this type of training out on the nOOT.

We didn't win the shield, to ay We were the best, 'twas not our day.

But deep inside, I've more than a hunch, We'll be able to cope when it comes to the crun ch. Percy J. Webb.

I AT RANDOM (conlinuedfrompage1)

helpers at the Uganda Asian Resettlement Centre at Gaydon, where throughout the emergency he hImself spent all his waking hours, c;ometimes remaining on duty for 20 hours a day. nd fin<Jlly, in this connection, the BEM was awarded to Mr. T. M. Lytham , County Staff Officer (Public Duties) for Essex, who co-ordinated the services of SL. John and the Red Cross and the WRVS at Stansteu airport in a manner which ensured the most happy and effective relattonship. He carried out this work with a tact and compasSIOn far beyond the normal calls of duty and for m<Jny week spent every available moment of hie; time at the airport, often giving up much of his night's rest, despite having a daytime job to perform.

The fourth member of the Brigade to be honoured was Mr. A. F. Hipwell, County Staff Officer for Ambulance Cadets, Warwick hire who received the MBE in recognition of 39 years' outstanding service to the Brigade in that county, during 28 of which he has been directly concerned in working with Cadets in a manner which e pecially during the IS years in which he has been CSO for Cadet (A) has brought exceptional benefit to the many hundreds of boys who have been under his charge and great credit to the name of St. John.

o doubt there are many others connected with St. John Ambulance who e names appear in the Birthday Honours though not directly in a St. John context; and though one would wish to congratul<Jte them all, at the time of writing when the ink of the London Gazet te is sC<Jrcely dry it has not necessarily been possible to identify them all. However , I hope it may not seem invidious if I mention two whose name have caught my eye: Lord Grey of aunton, KnIght Commander of the Commandery of Ards and Governor of Northern I reland, who receives the G VO; and Dr. J. S. Binning, Deputy Chief Medical Officer of the St. John Ambulance Association, who receives the MBE for his ervices as a senior medIcal officer to Briti h Railways.

Fire Risk

For the past two year J have carried in my elf one of those excellent little metal foil 'blanket.' which have been on sale at the Stores Dep<Jrtment in a wallet about the ize of a packet of 20 cigarettes and labelled (in ab olutely good faith) ·St. John Amhulance Safety Blanket'. My attention was recently drawn to the fact that there is a slight clement of fire risk with any material made of very thin metal foil. So I tore off a small corner of my blanket and tested it in the name of a match, and to my horror I found that it first of all began to melt and eventually burst into name.

These blankets were originally designed for usc by mountain rescue unit, and their most valuable asset i in the cons rvation

of body-warmth and protection against hypothermia due to exposure They have also the advantages of being waterproof, of showing up clearly at night, of having been tested as capable of lifting a IS-stone man, and of weighing only 2 ounces! I shall still continue to keep mine in my car, but I shall beware of usmg it in an emergency where there is any serious risk of fire. I'm sure that these blankets (price £1.25) would be a valuable addition to the first aid kit of many first aiders and of all Divisions. But, while encouraging you to buy them for use on suitable occasions, I felt it would be wise (and the Stores \1anager entirely upports me in this) to warn you that they are primarily intended for low temperature conditions and, though certainly not highly innamma ble, are by no means fire-resistant. The Stores are now enclosing with each blanket sold a note to the effect that they are for use in low temperatures only.

Th at Band age

Following my remark.s in the March Review about the history of the triangular bandage , when I aid I believed it had been invented by a Dr. Mayor of Lausanne in 1831 but that his idea never caught on until It was 're-invented' by Dr. Esmarch of Kiel after the incident that he witnessed in London 20 years later, Mr. J. E. Dane (a Vice-President of the Croydon As ociation Centre) has kindly written to me to say: 'The first de cription of the triangular bandage wa in the book called Popular Surgery by Dr. Mayor of LaLl anne, Switzerland, published in 1836. How long it was in u before this date is not known. The idea must be quite old because a bJby's napkin is a square of material folded along lhe diagonal when in u e thus making in effect a triangular bandage The use of the triangle for thi purpose may well go back into remote lustory, or even pre-hi tory. and the attention of a somewhat unheeding world was undoubtedly first drawn to its extended pos ibilitie by a Swi ' s doctor. But I stili take pride in the fact that it popularisation was due to the resource of a London policeman acting in an emergency, witnes ed by a German doctor whose developments of the idea in his own country were later re-introduced to EngJand by a daughter of Queen Victoria.

Dick w a s here

[ heard the other day that while members of Chapter-General were robing at the Mansion House during the St. John's Day celebrations last year, a black cat was suddenly seen wandering through the robing room. One of the Knights remarked in surprise 'What's that cat doing here'?' and hi neighbour replied '[ think it must have been left here by a former Lord layor.'

(Above) Founder secretary of the Association Centre, Wigan, Miss Irene Redfern recently received a Long Service Award (L

R) Mjr. Tom Spencer, District Secretary; Dr. R. D. Choudhury, Centre Sec; and CaPt. T N. Catlow,

Resuscitation Part 2

TECHNIQUES APPLIED TODAY

by J. P. Payne

ALTHOUGH the introduction of artificial ventilation was a substantial step forward in the development of resuscitation techniques, the difficult pro blem of replacing blood and fluid lost from the body remained As early as 1665 Richard Lower had shown that an exsanguinated dog could be resuscitated by the transfer of blood from a healthy animal, but it was soon recognised that transfer from one species to another was not only ineffective but often detrimental. Moreover, even in the same species satisfactory results were difficult to obtain and the first beneficial transfusion of human blood was not reported until 1829 when James Blundell successfully transfused a patient after a post-partum haemorrhage. However the general introduction of blood transfusion had to wait until after Landsteiner's discovery of the blood groups in ] 900.

About the time of Blundell's experiments with blood, Thomas Latta (1832) of Leith in a communication to the Lancet described the life-savin g effects 0 f saline infusions given in travenously to moribund patients stricken with cholera. But his arguments made little impression on his contemporaries and more than one hundred years were to pass before clinicians, largely as a result of experience in World War II, came to realise the significance of salt for the body.

Probably the commonest cause of collapse demanding resuscitation is trauma, and this is nearly always true when more than one patient needs treatment. A rare exception is the occurrence of fulminant infections, especially when the respiratory or gastro-intestinal tracts are involved. The severe respiratory insufficiency occasioned by poliomyelitis frequently warrants some form of assisted or controlled ventilation and the excessive dehydration of dysenteric disorders can lead rapidly to serious circulatory insufficiency demanding urgent treat m ent Apart from trauma certain conditions dangerous to life may develop anywhere at any time. The occurrence of acute coronary occlusion frequently requires resuscitative measures and less commonly cerebro-vascular accidents

12

J P Payne, MB, CH.B, FFARCS, is th e Director of the Research

Departm en of Anaesthetics, Royal College of Surgeons of England, Ullcoln's Inn Fields in London. demand si milar attention Sudden haemorrhage either from a peptic ulcer or as a complication of pregnancy may be sufficiently severe to require immediate transfusion ; even spontaneous bleeding fro m the nose may need simila r treatment.

Rarely an immediate severe and sometimes fatal anaphylactic shock, manifested by acute respiratory obstruction and hypotension can develop following exposure to an antigen to which the victim has been previously sensitised. At one time this co ndition was almost invariably due to the venom injected by stinging insects such as the honey bee and the w as p , but recently the development of drugs capable of combining with body proteins and the greater use of parenteral routes of administration have made drug therapy an increasingly important cause of anaphylactic shock.

The fact that the need for resuscitation can arise from such a large number of causes and under such a variety of circumstances would seem to imply that the organisation of resuscitation and rescue schemes would be virtually useless. Yet the high risks carried by certain occupations and recreational activities make it mandatory that certain precautions should be taken In some occupations, for example, in the chemical indu s try in coal-mining and in deep-sea fishing, the pattern of accidents can be reasonably well defined and a suitable safe ty code adopted and enforced by government legislation if necessary. In others, such as the armed services, the police force and the fire service the risk s are les s circumscribed but are counterbalanced by a combination of greater personal di sci pline and the provision of special training in first-aid.

In the recreational field, the increased leisure time and the greater personal wealth made available by the ,teady improvement in the standard of living have encouraged people to engage in activities which for lack of ski ll failure to appreciate changes in weather conditions or sheer mi fortune can lead to accidents in isolated or even inaccessible areas, Among these activities are mountain climbing, pot-holing, ski-ing, swimming, boating, car racing and private flying and gliding, all of which by their very nature render continuous uperVISlon impracticable. Only when condItions are reasonably ci r cumscribed such as in ski-jumping and on motor racing circuits ca n immediate assistance be made available in the event of an accident. Re su citation procedure fall into two categories. First emergency measures are effected to protect the victim and if necessary to restore vital functions Secon d more specific therapy is introduced to deal with individual problems such as pain, hypoxia, tissue damage fractures and blood or fluid loss.

In most instances the emergency treatment consists of laying the victim flat, maintaining a clear airway, sheltering and providing warmth in cold exposed situations or shading from the hot sun; often reassurance may be all that is required. If bleeding is persistent it must be stopped or at least minimised by packing the wound which in any event should be protected from con taminati on.

In patients who are moribund or apparently dead, full cardio-pulmonary resuscitative measures should be started. If not delayed the use of mouth-to-mouth ventilation combined with external cardiac compression is effective in reducing the loss of life when s udd en respiratory or ca rdia c ar rest occ ur s as a re su lt of trauma in otherwise healthy individuals, and even when cardiovascular or other disease is the ca u se the mortality is significantly reduced. It follows the ref 0 ret hat to be successful resuscitative mea sures must be started :1t the site of the incident without waiting for medi ca l assistance or for specialised equipment, and that relatives, friends and colleagues of the victim must be familiar with the methods of resuscitation.

The success of the Norwegians in training their primary schoo chi ldr en to carry ou t arti fi cial venLilaLion by the moutil-l ')- mouLh (Fig I) and the mouLh-tono,e method s has ed to a general acceptance that the techniques shou ld be widely taught. Oninions arc less unanimous about the advisability of teach1l1g the techniques of external cardiac compression to laymen. But whether or not doctors approve, the fact remains tha t few people are pre pared to wa tch a victim die without making some attempts at reSLlscitatlOn and this is particularly true if a close re l ative or a young child is involved. It is sensible therefore to ensure that this effort is properly directed by making instruction in ca rdiopulmonary resuscitation as widely available as possible.

The techniques of cardiopulmonary resuscitation are simple and easy to learn. They have the outstanding advantage that no special equipment is required; the would-be rescuer needs only hIS hands to com pre s the heart and a sufficient vital capclcity and reserve of energy to inflate the lungs.

[n carrymg out external cardIac compres ion It is important to avoid damage to the ribs or to underlying structures such as the liver. For this reason it is recommended that when pres'ure is applied to the chest only the heel of the hand should be ll ed with iLs long Jxis agclinst the lower end of the sternum (Fig. 2). The other hand i then placed at rIght angles over the first to provide additional pres ure and with the re cuer po itlOned at the side of the victim ufficient pressure to move the sternum 4 5 cm. should be applied regularly 60 time per mmute m the case of all adult, a faster rate, of the order of 100 tImes per minute is needed for chIldren. Compre sion is more effective agaInst a firm background so that if the victim i lying on a soft surface a board or tray should be placed under his back at the first opportunity. If the rescuer is alone the cardiac compression should be interrupted every 15 seconds to allow two rapid and full lung inflation by the mouth-to-mouth or mouth-to-nose method and thiS sequence should be continued until help arrives. If a second r escuer is present the lungs can be inflated once every five second without disturbing the rhythm of the cardiac compressIOn.

Often pontaneous respiratory and cardiac activity return as soon as the hypoxia has been relieved but sometimes prolonged resLlscitative efforts may be needed and shou ld be main tamed until the patient is admitted to ho pital unless there is LUlcontrovertible evidence of death. There th e decislOn to di continue resuscitation in the absence of signs of life is the responsibility of the receiving cliniCIan preferably in consultation with an experienced pecialist.

2. The method of applYing external cardiac comp ression

The decision to begIn resuscitation is sometimes equally difficult and should not be att mpted if the victim ha s been dead for more than ten minutes or if he wa known to be in the terminal pha e of a fatal illness. If the circulation has been stopped for longer than five minutes almost certainly irreversible brain damage will have 0 curred, but the re cuer confronted with an apnoeic pulseless victim rarely ha such precise information available and he has little choice but to InItiative resu citative efforts The medico-legal and ethical problems associated with Llch efforts have been considered in detail elsewhere and are publi hed in the 'Proceedings of the econd Intern ational Symposium on Emergency Re cu citatlOn'.

Once the immediate problem of maintaining the vital function ha been accomplished further therapy must await

the arrival of the doctor whose first task is to establish the type of arrest. In particular a distinction needs to be made between circulatory failure due to cardiac asystole and that caused by ventricular fibrillation; in the latter case normal rhythm may not be restored until the heart defi brilla ted electncall)-, Since the fundamental defect caused by cardiac arre is a failure of tissue perfusion the next step in treatment after the circulation has been re tarted is the relief of the consequent anoxia. For this purpose adequate ventilation preferably with oxygen (FIg. 3) and fluid replacement in patients whose circulating blood volume has been reduced meet the immediate requirements. The use of a strong analgesic such a morphine lessens anxiety, relieves pain and makes the resu citative efforts more tolerable. To provide artificial ventilation over a

Figure 1. The mouth to mouth technique

Figure

Figure 3. The use of a portable oxygen unit for resuscitation The oxygen is contained in a special coiled storage unit with a capacity of 300 litres of oxygen Figur e 4 The Laerdal Resus ci·bag, (top) packed in a storage container; (above) extended togethe r with airways facemasks and connectors

prolonged period either with air or with oxygen several types of hand-operated self-inflating bags have been introduced for emergency use and some have recently been evaluated. Two of the most popular are the Ambu resuscitator and the Laerdal Resusci-bag (Fig. 4) , the Ambu-bag is composed of neoprene rubber which is highly resistant to light, heat and damp. The Laerdal bag is made of a transparent plastic material and is equally resistant to these factors. Both self-infl ating bags have one-way valves to prevent rebreathing and the accumulation of carbon dioxide ; in addition a sui table attachment on the inlet valve enables oxygen to be substituted for air. The need for oxygen in the immediate post-arrest period is virtually universal , even in those patients in whom the return of spontaneous breathing appears to be both prompt and adequate, and it s hould be provided as soon as possible. The reason is that almost invariably after an arrested heart has been restarted its output only slowly returns to normal. Since the supply of oxygen to the tissues is dependent on the cardiac output and on the ability of the blood to carry oxygen a defect in one or both of these variables reduces the oxygen availability, sometimes substantially, especially in those patients in whom the cardiac arrest

14

is associated with blood loss. If the question of blood or fluid repla ce ment arise, l ong -t erm man age ment demands matching the type of fluid given with the patients requirements, but in an emergency situation volume is more important than content and virtually any fluid will meet the immediate need. This approach 11as the added advantage that it allows time for blood gr oup ing and cross-matching s hould blood tran s fusion be n ecessary. I n this connect ion it is co mm o n experience that almost invariably blood and plasma los s is under-e s timated particularly In those patients who s uffer crush injuries. ormally the protective m echa ni sms in the cardio-vascular system a re geared to protect the integrity of the circ ulating blood volume. Thi s commonly occllrs a t the expense of the ex tra ce llular fluid the volume of which may be furt her depl eted by locali se d oe dema or by su rfa ce l oss from large areas of superficial tissue damage as in burns and calds. Th e requirement therefore is for a fluid similar in com positi o n to that of the extracellular fluid , and in this respect the use of Ringer-La c tate solution has recently achieved wide acceptance. In the Briti sh Pharma copoe ia preparation Ringer-La c tate is a hyp o tonic solution with a pI! in the range of 5 7 unit s, and

th e period o f arrest. The development of ce rebral oedema m ay be indicated by d e lay in th e recovery of consc ious ne ss or by a furth er lo ss of consciousness after apparent recovery. In these circumstances th e usc of hypertonic so luti ons such as 20 per cent mannitol (I lit re in 24 hours) shou ld be considered. Alternatively the use of I sodium bicarbonate solution (8.4 per cent ) will tend to prevent the onse t of cerebral oedema by increasing the osmo larity of the extracellu ar fluid an d a the same time the trend towards metabolic acidosis wilJ be reversed by the inc r eased concentration of base whIch will neutralJse the accumu lating hydrogen Ions. The dose, of the order of I 3 mEq per kg. body weight, can be injected rapidly without the risk of overtransf u sion Sl11ce the volume required is small.

One fina l a pect of cardia-pu lm onary resuscitatIon deserves consideratlOn. Any patient who h;)c; developed respiratory or

FILMS

one litre contains 131 mEq sodium ions, 5 mEq potassium ions, 4 mEq ca l ciu m ions, mEq blcarbon:.lte ions :.IS lactate and 111 mEq chlo rid e ions.

Th e amount to be given poses another problem. In ho pita l blood and flUJd loss can be determined with reasonable accuracy, but at the road ide or on th e battlefield on l y an approximation can be made. [n the initial enth u s ia sm for Ringer-Lact ate very large volumes were given without apparent h:.lrm to the patIent, but as experience accumulated It became evident that when the o lution was used over a prolonged period pulmonary oe dema dev el oped 111 some patients. In th e immediate treatment of shocke d patients however this ri sk i slight and the rapid transfusion of several litres of Ringer - La cta e solution will often protect the victim until supplIes of blood or plasma cun be obtained. An excep tion is the situatlOn where ca rdi ac arrest is known to have occurre d In such patients ce r ebral oedema is a common comp li ca tion in the recovery period an d particular care is needed in the choice not only of fluid but also of the volume to be used. Two cons iderati o n in particular prevail; o n e is prevention o r treatment of the cerebra l oedema and the second is the reversal of the m etabol ic acidosis caused by th e inad eq u ate tissue perfUSIOn during

cardiac arrest must be admItted to h ospital for further observation and treatment, but many such patients tolerate movement badly and their transfer to hospital can raise additional prob ems. First , frequently the state of the circulation is still precarious and even the postural changes brought about by c;tretcher manipulation may be sufficient to induce a further cardIac arrest. Secondly, the patient is often particularly vulnerab le during the ambu l ance journey, partly because many ambulances are not equipped to deal with emergency situations and ambulace crews are not always suitably trained. Thirdly, the frequent braking and acceleration necessitated by modern traffic conditions impose additional strains on the victim, particularly in the case of fractures and head injuries.

Attempts have been made to deal with these problems by providing doctor-manned ambulances equipped as

ONE WAY TICKET (1971) (Col. 23 mins.) Hire

Oi tributed by Guild Sound and Vision Ltd., King ton Rd ., London SW 19.

Produced by Sout:1 Stafford s hire [vledical Centre.

I ntended as part of a teaching programme for children 14/17 years, a dramatised documentary on the subject of drugs in modern society, it discllsses some of the effects of cannabis LSD amphd;)mines, barbiturate and to a lesser extent heroin.' , If it necessary to produce fIlm about drugs of dependence it IS desirable that they should relate to the mores of Ollr tImes the fact thdt this film is produced in the UK is in its favour. The panel IS not convinced, however, thJt the screening of films IS a deterrent to children and, in some c;)ses, may even, unwittingly, arouse undesirable curiosity. The film is moderately well-produced and is accompanied by teachers' notes.

Audience: ot recommended for exhibition within St. J ohn.

ONE MAN'S CHALLENGE (1957) (B & W 20 mins.) Free

Oi tributed by : British Medical A soeiation, BMA House, Tavistock Sq. , London , WC I.

The story of a man who having becomt) a helpless cripple through years of affliction with rheumatoid arthritIS, overcomes by his ingenuity and determination his severe handicap. The film follows his progre s and shows how he tac:.1cs and conquers obstacle:;.

This 15 year o ld film does not reflect modern SOCIal conditions: nowadays local a uthoriti es would as ume greater responsibility than is e vid ent in th e film: none the ess, the film does offer the message that patient morale i of great impo rt ance and 'self-help' is of t en the best help.

Audi ence: Universal to all interested in social welfare cases.

ONE MOMENT PLEASE (1971) (Col. 12 mins-l

Di st ribut ed by : Stewart Film Ltd., 82 /8 4 Clifton Hill , London NW.8.

Sponsor : British Oxygen Co

Parti c ipati o n in accident preventIOn is encouraged by highlIghting variou incidents throughout the sponso r's activities.

Th e panel co nsidered thi an effective sa f ety film: it d eal in general terms with examples of d anger situatio n but these arc

mobile intensive therapy Ul11ts, but the expense invo lved has dic;couraged most ambulance authorities. Similarly the use of helicopters for the rapid transport of casualties pioneered by the Armed Services and developed by some civil authorities in areas not readily accessible by other routes, as for example in the jungles of Western Malaysia, has not recei ved the support it deserves, presumably for the same reason. The provision of such funds is ultimately a social question and society must consider the logic of maintaining every facility for the resuscitation of the dying in hospital while the fate of the roadside victim, the industrial casualty and the domiciliary cardiac patient, except in rare instances, is largely left to chance.

This article appeared in Teach-In and is reprinted by permiSSIOn of the Editor and Update Publications Ltd.

large. It is well produced, in good colour and technically unimpeachable. Audience: The dividing line between safety and first aid is narrow and this accident prevention film will be useful in many St. John programmes.

I T'S UP TO YOU (Col. 12 mins-l Hire

Distributed by: Guild Sound & Vision Ltd. , Kingston Rd. London SW 19

Spon or : Briti h American Optical Company.

This accident prevention film expounds upon the absolute necessity of wearing eye protection devices in high risk situations. I t tells the story of an American worker who nearly ost an eye because of carelessness.

This American afety film uffers from the drawback of an alien commentary and poor quality; on the other hand, it get its safety message across with a punch by showing the result of careles ness in one instance - an eye operation. udience: Those workers in industries where eye protection is desirable and suitable for 1l1duction courses. ot of dire ct interest to St. John.

LIVING DANGEROUSLY (1972) (Col.21 mins-l

Oi tributed by : Little, King & Partners Ltd., 93 95 Wardour St., London W.1.

Sponsor : Servior Laboratories Ltd.

An overweight 'youngish' executive has a se dent a r y job. He hurries to his company medical examination where he is t o ld that he i overweight and that thi dangerous. He asks many of the questions that we would all lik.e an wered and, with the aid of some electronic magic, the doctor attempts to an wer them.

The panel considered thi an excellent film that with 's oft sell' approach emphasl e the di advantage of gluttony or over eating. The film does not confine itself to 'm iddl e age' pread but e mph asises too that a fat baby not nece sari ly a healthy baby.

A well produce d film, perhaps a shade lengthy for its message, but nonetheless both in tructional and entertaining.

Audience: Ala, the audience for such a film in this country is nearly univer aL Of value to St. John in public health and hygiene co ur c

First Aid Unit

DEARNE V ALLEY Combined Division, near Huddersfield, recently chose a trailer conversion rather than a self-propelled vehicle for its new first aid unit. Here are the reasons why.

Division: coun try area, 26 mem bers (combined ambulance/nursing).

Duties : Fetes, galas, motor sports, point-to-points, marathon walks, etc.

Choice of vehicle: a) Availability this vehicle was available for £30; b) utilit y as the vehicle was old it could be totally gutted, refurbished and fitted to take a stretcher; c) it could be towed by one of the ambulances already operated by the division; d) insurance is lower than for a self-propelled vehicle; e) only one dr iver would be needed [or any duty for which the unit was required; f) no fuel or engine maintenance costs involved.

Finance : this became available through the local Round Table about a year after we had bought and gutted the vehicle.

Pur chase (approx) £30, relining and rear doors £70, adapting towing vehicle £20 and remainder including interior £30. Original material re-used included electric and gas lighting, cooker, sink, and the stretcher-back was taken from an ambulance.

We had one severe set-back after commissioning the unit. The draw-bar, which had been adjusted by the previous owner and seriously weakened, subsequently bent. After trying to straighten it with welding equipment the entire bar had to be replaced, and altogether this involved a cost of £ I 00.

We came to the following conclusion In no circumstances would we buy a commercial holiday-type van. A purposebuilt shell should cost £300 to £400, and this can be easily equipped for stretchers. No holiday-type van that we've seen can be satisfactorily adapted.

We see little value in the self-propelled unit for our requirements, with an expensive engine being carried to the site and then lmmobilised. Our towing vehicle, an ambulance, is available for use once the unit is on site 16

Elecmcs:

Towing pcllicle: Generator fitted: 7 pin connector to trailer. Towing vehicle charges trailer battery whilst towing. NOIl-retllrn diode fitted.

Trailer: Transistorised fluorescent ligflting worked from battery normally carried. Ex-ambulance bulkhead light ill raile!.

White side-lights fitted as well as red rear lights. If the trailer has to be left in an emergency, all 'obligatory' lights call be left operating by inserting plug into 7 pin socket mounted all the front of the trailer.

Refitting

An intensive refitting programme has been completed of Kingston upon Thame Ambulance Division's ambulances by the members so as to bring them lip to the latest standards set out by the Ministry of Health.

The work included:

Respraying one vehicle; Engine overhaul of two vehicles: FItting of new interior fluorescent lights:

Special high-power rcar light s for L1SC' in fog; Il azard warning li ghts; 100mm rcnectlvl' on each ,ide; 150mJll reflectivc character 'i on the roof; Sump heaters to engines : Audiblc warning deVise , used when reverslJ1g :

New aerials, suitable for the Sl. John Ambulance radio network: Reflective registration plates: Fog lights;

More

Scoop l ntonox <Inalgesic apparatus; RescLle equ pment; Built-In hattery charging systems; New pattern (B.eF.) fire extingulshc rs ]jattery master switches; fIre blanket<.; l- lectronic ignition; Split vision rear view mirrors

Most of the new equipment was donated by local business hOLlses or by the manufacturers

though t s on Bleeding

by DR. ALLAN WALKER

TH :-OIAY ST. JOlIN RIVII W I tfled to give some guidance about external, VISible bleeding. No\\ I want you to think about bleeding \\ hlch is not viSible, bkedlll!! Into the tIS\UL'S or from Internal organ s

Accident can produce internal bleedll1g as in lrat.:lures or crush Injune\ dama"In" or"ans of abdomen or chest, or of chest or abdomen.

DI,ease can produce Internal bleeding ulcers

In the gullel: stomach or duodenum: diseased condition of or of lungs.

1'0110\\ Ing severe Injury, blC'edlll!! cun be both and Internal, for example where there ure bleeding \\ ound\ of limbs as well as internal II1juries or \\ here there arc penetrating wou nds

Bleetill1g Into the ti"ues sho\\'\ Itself <), s\\ellmg Thlllk of the \welling thut can appear In an Injured leg or especlallv in a thigh, \\ here a \\\ elllllg which InCrC;l\es the tklmeter b} one lI1ch mal mean the loss to the clfculatlon of up to two pinh of blood.

Bleed ing stops because damaged ve cis retract and close up, because blood clots at the torn ends of ve sels and because the pressure built up In the ti\Slles by till: blood \\ lilch ha\ escaped help to compress the damaged vessel. Vessels 1Il bones are not able to retract. That IS one reason \\hy there i, often much bleedll1 0 \\ith fractures. ThiS IS commonly seen \Vith fractures of the femur.

I n the abdomen therc is space in the cavity for a ot of blood , the organs there arc mostly soft and can be compressed; the liver, spleen and kidneys hold a vcry large quantity of blood. I is in damage to these organs that the moq severe Internal b eeding is likely to occur. Several pints of b lood may bleed into the cavity of the abdomen and tillS is lost to the circulation just as truly as If It had run do\\ n the gut ter. ('rushll1g injurle arc prone to produce such damage. Penetrating wounds of abdomen or chest, however sma ll, may produce untold havoc InSide ;Jnd Illust always bc treated as dangero us nJ II rIes.

Bleeding inside the skull must calise compression of the b rain as the bony skull cannot stretch and bruin tissue IS soft. S u ch b leeding occurs from accident, often \\ ith

The casualty's skin will be cold and may be moist. I Ie will become increasingly short of breath. At first fully conscIOus and alert, he IS likely to become faint and dIZZY and to become Increaslllgly disinterested and distant. I have seen this appearance of not belllg with us come on remarkably quickly and be the first sign that all was not \Vell with my patient. Yet again there can be an apparent contradiction. I have learned to beware of the patient who does not appear to be nearly so ill as the extent of hIS injuries would lead me to expect. Such a man may be quietly bleeding his life away and though he appears too bngh t and talkative, he may be hovering on the brlllk of disaster and may suddenly collapse have left the most importan t sign to the last. I refer to the state of the pulse. Immediately after an accident the pulse may be fast or slo\V or even irregular. As the initial nerve shock passes, it may well settle dO\l n to be regular and the rate only slightly raised. If bleeding contll1ues, blood pres<,ure continues to fall and the pulse become weaker and weaker until eventually it disappears. [f bleedlllg IS stopped there \\ ill be a slow Improvement in the state of the pulse. Do not forget an apparent contradiction which may show In head injury. Bleeding Imide the skull cau es com pre sion on the brain and compre'i ion makes for a slo\V pulse.

fractures of the skull and In strokes when bleeding arises from diseased arteries_ Internal bleeding may sometimes become VISib le Blood from stomach or duodenum may be vomited; blood from lungs may appear in the \Pl t: blood from kidneys or bladder may appear in the urine: blood from skull inJurie, as bleeding from cars or nose But \Iatch out for the traps! I remember ,eeing a man \\ ho did not vomIt till 24 hour, at'te; bleeding into his stomach. Another man I sa\\ rccenll\ had fractures of several ribs and a 01 0 into his chest , squeezing hiS lung and o cauSing ;;'uch difficulty in breathing. Yet he had no external I\ound nor did he blood A bad nose bleed or bleeding in the mou th IS likely to be followed by sPlttlllg of blood and vomiting of swallowed blood. Damaged kidneys are as likely to bleed in to the abdomen as into the bladder: damage to the bladder is as likely to make the injured person unable to pass waler as to produce blood in the uri ne.

Blood appearing \\here It should not norm ,Jtly be \hould al\\ ays be taken senoush. however slight. B ood in the spit: blood in th'e vomit, be it red or coffee coloured: blood in the unne. rcd or smoky: blood from the bOllel, be It red or blal.:k us tar any of these demand medical attention and full IIlvesti o ation

But it is the emergenc) of internal bleedlllg that concern us nO\I_ 1101\ 1\ ill it shO\\ ? \\ hat \\ ill make liS think IIlat it IS going on'}

Anyone who has lost a lot of blood \\ ill look Ill. He 1\ ill lo,e colour, his face \\ ill become pale The happem because the blood vessels in the skll1 have contracted so that the reduced quantity of blood remallling may be used to supp ly the brain and other vital organs and to keep up the blood pressure If bleeding continues, blood pressure continues to fall. The loss of red cel ls means that the blood cannot carry cnough oxygen for the ti,sues. At first this is countered by an increase in th e rate of heart contraction making the blood do Illore \\ork. But o\ygen lack gets progressively \\,or c and sholl'S itself a blue or purplish tillge of lips, lobes of cars, Ilose, check und under fingernails. I n thiS state the ca ualty has probably lost three or four pints of blood:

You mu,t therefore realise that regular observalion of the pulse IS the mo,t important observation in cases of suspected internal bleedll1g The pulse rate mu<;t be counted and written dOI\ n at regular interval"

lost. This mean blood transfusion and surgery, if required, to stop the blceding. So any ,uspected bleed ing demands Immediate transport to hospital as a stretcher case. While awaiting the arrival of the ambulance do our best t; stop the panic. Comfort lI1jured person, and see that he is kept completely at rest, for movement of any kind IIlcreases bleedll1g. He should be lying do\\ n, his head on a 101\ pillo\\' and his lower limbs, if not fractured, raised above the level of hiS heart. Quickly examine for injuries. ('ontrol external bleeding, cover \\ounds, Immobilise fractures, usc blanket., cushiom. pillo\" to upport injured parts and to relieve pain. Cover over to prevent fmther cold give nothll1" by mouth however much he of thir°t. Accompany him to hmpltal, \\ atchIng carefull) his condition Above all keep that regular observation on his pulse and state of comciou nes \\ hich you \\ ill give 111 \\ riting to the hospital.So have a little very elementary remll1der. Do make sure that ) ou knol\ how to take a pulse and that you arc truly famtliar \\ Ith the feel of a nonnal pulse HaVing taken mall) examination and judged many competitions, I have noted that far too manv first-aiders have not practised observation of- the pulse nearly often cnough.

So \\ hat is the lesson \\ e must dr:J\\ from all this talk abou t bleeding? Surely that the care of injured people calls for continual and clo e observa ion. Vigilance is ever required so that no man allowed to die just because no one has realised that he i., bleeding to dcuth.

(Reprillted frolll The Electricity Coullci/'s A mbulallce Blillerin).

Kingston Ambulance Division's vehicles after refitting.

FIRST AID IN SCHOOLS

fr om R C. Rook e, Ambu lance Member

After completing my training as a school teacher, I have been m ade aware that many school curricula do not include a very important subject - First Aid.

Since my appointment in 1971 to Withyw ood Comprehen ive S chool, Bristol, with the agreement of the headmaster, I have tried to rectify this in the chool. My first problem was to intro du ce the s ubj ect to the pupils. The first tep was to enlist the help of a Brigade nurse and his wife. We started a First Aid Club, meeting after school for one hour a week. This ed to the Essentials of Fir t Aid Certificate. My next step as a Fifth Year Tutor was to introduce first aid to my tutor group. This wa very successful and led to regular co ur ses open to a ll the fifth year students who also sat the Es entials of First Aid Certificate.

After one year, first aid was beginning to take it place in the school curricula and was time-tabled for the sixth form as a gene ra l subjects topic Many co lle agues of the staff were beginning to show an interest and a ked for a cour e to be arranged for them This was done with the help of a l oca l doctor, lea ding up to the examination at the en d of the cou rse. The sixth form students who already held the Essentials of First Aid Certificate were invited to join this co ur se. During the present academic year the fifth year courses have continued, a course was held for the Duke of Edinburgh A ward Scheme, and the First Aid Club continued with a nursing course.

Withywood School now ha s I 13 pupils with the Essentials of First Aid Certificate and 27 staff and s ixth formers with First Aid Certificates. Our aim now is to enter first aid teams in l ocal co mpetition s.

I hope it will not be too long before mor e schools introduce this important subject into their curricula, and more Brigade members get the satisfaction a nd enjoyment which can be experienced in the teaching of first aid in school Bristol R. C. Rooke

INJURY IDEA

from D avi d Hearne , Cadet Sergeant

Whil e thinking of the different injuries which people encounter, I though t out a method of dealing with an injury to, or a fracture of, an amputation stump (Fig. I).

Pl ace two triangular bandages one on top of the other (Fig. 2) and pin together as shown on diagram Fold to just above and below the fracture (Fig. 3). Bring the two sets of ends ,ogether and then tie together (Fig. 4). Windsor, Berks. Da vid Hearne I , /\\

Fig 1 Amputation stump, uppe r

F

READERS VIEWS

Readers views and opinions, wh.lch should be sent to the Editor, although published are not necessarily endorsed by the Editor or the Order of St John and Its Foundations. Although readers may sign published letters With a pen name, writers must supply their name and address to the editor

The Deputy Chief Medical Otficer, St. John ASSOCIation, comments: Thi IS a good example of anginal thinking and has been pubhshecl t o encourage 01 hers to do likewise. II1 Jufles to amputation stumps are rare but there is always a first tIme in everything.

MNEMONICS

from B. Wallace

I'm writing to say how much I enjo) ed the article in the June '72 Review ol1mllemonics Deities & Diabetes'. Here ,Ire .1 few first ai d mnemonics of my own.

Th e requirements of a SPU T:

Strong enough to uo the Job

Padded well

Long cnough and Wide cnough

Imm obilizing the JOInts above and belo\\ the II1JlIl]

ot tied too tightly

Tied over the clothing

General rules for the treatment of wounds accompanied by haemorrhage: PEEL RADISH:

PO Sition patlcnt

Expose wound

Elevate part II possible

Leave blood clot, alone

Remove foreign bodies that come a\\ay eaSIly

Apply pressu;e direct or indirect

Dr ess wound

I mmobilize part, cspecially ncar jO ints

State blood loss

Hasten o hospital if condition serious.

Common causes of unconsciousness CHIEF SAPHEAD:

Concussion and compression

Heart attacks

Infan til e convulsions

Execs ive heat

Fainting

Shock

Asp hyxia

Poi sons

J-I ystena

Epilepsy

Apoplexy

Diab etic coma and InsulIn ovcrdose

The Golden Rules of First Aid: FRATERNAL:

First thin gs first

Restorc breathing

Arr cs bleeding

Treat shock

Essentia l work only

Rea ssure casualty

No crowding

Arrang e speedy disposal

Leavc clothing if possible

Mr s Kay Poole, RN, a friend of min e, uses the following

se ntenc e to show how oxygen reaches the tissue ce ll s: A Child

Alway s Lik es Butt ered Toast:

Atm ospherc Chcst movements Air passages Lungs Bl ood Tissues

RT EQUIPMENT from N. Soley

[ would like to inform all diviSIOns through the Review that T have radio telephone equipment, both portable and vehicular systems, availahle to any St. John dIvi s ions which could use It.

As a mem ber of the Association I am prepared to charge only expenses for the use of thi s equipment, which has the full approval of the Po st Office for use anywhere in the UK. Get in touch with me at: Cornerhouse Westmancote Bredon

And if you want to remember the tongues of the Order in history: r. Tewkesbury, Gloucs, GL20 7EP, Bredon 330.' , N. Soley

INFO WANTED

from A. J. Sharkey (cpl).

This detachment , which includes se veral members of the St. John Ambulance Brigade, would like to compete 111 first aid, nursing and similar competitions in the Hampshire, Sussex or Surrey area. Perhaps anyone who knows of suitable competitions would write to me: Brighton Detachment, 217 (L) General Hospital RAMC/V, Territ oria and Army

A. J. Sharkey Basil Wallace SENs

from Rex In gram, County Staff Officer

A

RECORD?

The picture of Gosport 's Alverstoke Ambulan ce and WhIle reserving my co mmen ts on the rela tive value of competitIOns, may I put Lilian Riley (May Review) right on one point about SE s? It is a statutory requirement of the General ursing Council that pupils for enrolment receIve first aid instruction, and this with their studies in allIed subjects brings their level of training well up to the standard of the bone fide Brigade member.

ursing Division 's 8 past and present members who are members of the Order, publi hed In the April ReVIew , has brought another letter from Middleshrougb Central Ambulance and Nursing DIvisions, they have 24 members of the Order, and 3 more who passed through the division. Total 27.

Beat that one.

Order Investiture

AS COMMANDER (BROTHER)

Peter Stanford London, \[1:31 ·, I RCS. (Wham)

Donald Vaughan, MRCS, LRCP (Norfolk)

Charles John Nigel Longmore, DL. (Ilerh)

John Laurence Wilkinson (Glos)

Coloncl I rancis Cuthbert DL. ( orfolk)

lexander Irving: Crum i:.Ivlng, OilL. (Guyana)

AS OFFICER (B ROTHER )

Ronald Cross ley (Lancs)

DaVid Francis 1B. BS, DObst, RCOG.

Jam es hnr),s O\\'en, \IRCS. LRCP. DRCOG. (Plymouth)

William Stockwood (Lincs)

Lt. Col. Gcorge Maxton \lacalpine Mailer·llowat, Me.

Thomas J.:.d\\'ard Davis (Worcs)

Sydney Ri chard Smith (E scx)

Jack Bo\\en (London)

Kenncth Reuben Sylvester Mitchell , SR (Warcs)

Arthur Fke (B'ham)

Joseph Ed\\lIrd WillIams (Lancs)

Vivian John Moorfoo! (F 'se x)

John llenr y Thornton (London)

Kenneth Thomas Farn, MRCS. LRCP. (Warks)

Ja ck Hilt on Charles WlI1ter (Berks)

Peter Laurcnce Pendry, BFM. (Bucks)

Richard John Crapp (Cornwall)

Sidney Kni ghton (DL'fbys)

Samucl Brick (StaITs)

Roy Weaving JoplIn g, BEM. (Suffolk)

Stanley Edward Baldwin (S urr ey)

AS ASSOCIATE OFFICER (B ROTHER)

Leon Jo seph Tamman (Sussex)

Carl Jam es St.Cin, MRCS. LRCP (Dcvon)

MAY 17 1973

AS OFFICER (SISTER)

Evelyn Alicc, Mn. Silver (London)

Mary lIettie, Mrs. Cullup (Northants)

Lilian, Mrs. IIod croft (Lancs)

Clara 1:1izabeth, :-'lrs. Brick (Staff)

May, Anderson , SR .OH e. (Derbys)

Jo an Audrey, :-Vllss Frieze, SR (Britol)

Marion Ro\\e, Miss Rady (Cornwall)

Willifred Henrietta, \Ir s. Carter (Lancs)

\I ary, \Ir s. Stoel,s (ER. Yorks) "label Pauline, Miss Hall (Bucks)

AS SERVING BROTHER

Emrys John Morris Hopkins, MB, ChB. (Lanes)

Ld\\ard Hethersett Charles Garnier \1 e. (Norfolk)

Jamc Terence Baldl\ in (Lane)

Richard \\ t1braham Walker, OBL QPM. (Berks)

Lt. Cdr. James I larry Hig .o n, DSe. RN. (Lancs)

Wardmaster Sub·Lt Robert Wyllic J ewi tt, (Royal Navy)

TIlc Rcvd. Francis Joseph Leonard (Herts)

Frank Bell (BritlsiI Railways)

TIlOmas Edwin Sadler (Min of Defence)

Raymond Frank (L3ncs)

Lioncillow:ud Bradlcy (British Railways)

Arthur Duddll1g (WR Yorks)

Thomas Richa;d Constable (British Railway)

Denni Reginald John Doney

John Birch Dm\ ber (British Railways)

Cyril WIlley ( Police)

John Bcrnard 00\\ nes (British Railway)

Geoffrey Ball, SRN. (Hong Kong)

Clar ence Parker Eastman (British Ral\\\ ays)

Jo seph \Villlam GOUld (London Transport)

Ivor Flo\\er (Britlsll Railways)

Ivan FRCGP. FRSH, 1 RCS, LRCP, S. (Lancs)

oel Rodncy Herbert (Bri ti sh Rail\\a) s)

Cleon Whitc, ChB, Oil\. (B'ham)

Henry Arthur Liandaff :-'1athews (Devon)

William Henry Philipson (British Railways)

Edward Francis Ben Powell (B ri stol)

Cyril Arthur Roebuck (British Railways)

Eric Oxley, BEM. (WR Yorks)

John Derek Patt on (Lane)

Thomas Alfred Smith (BritIsh Rail\\ ays)

\Villiarn Douglas Taylor, ChB. (Jersey)

William Lawrcncc Frederick Turk (London)

John Ed\\ard Ufton (British Railways)

Captain Richard Clive Streeton Hind (;-"rorth'd)

Anthony Leonard a'Court Robinson (Bristol)

Frederick \Villiam Charle Williams (British Rail\\ay )

AS SERVING SISTER

Irene Yiattic, \1i s Lainson (London)

Vera Maud, \1r s. \laynard (Co.Durham)

Phyllis Flizabeth, Us. Ricketts (London)

Tes a \lary, Yates (Lanes)

Bertha, ;".[r Ketley (London)

Elizabeth Mary, Peat, SR , SCM. (WR Yorks)

Kat ie, tl'tiss Farmer (London)

Agncs Wil on, \1i ss I\lather, SR , SCM, HV , Q (WR Yorks)

Dorothy Violet, l'Iliss Dudman (London)

Bet ty, li ss Wrigh (London)

l:.thel I\largaret, "I iss Panting, MBE. (Briti h Railways)

\l ary, Hardillge (London)

Kezia Sarah. Ward

J essIC L:lizabeth, Mrs. Ho\\ ell (London)

Amy Edith, :-'lrs Green (London)

OFFICER (BROTHER)

HarrIson received the Insignia of Officer (Brother) on behalf of her late hU band Walter Beaumont Hamson.

NEWS from SCOTLAND

CHRISTIA ITY has never been more 'muscular' than it is today. In every church, along the spectrum of Christian beliefs, the emphasis is on action ratllcr than on devotion, on the care of others rather than on contemplation, on practical work rather than on prayer. To put it another way, we stress more our love for our neighbour than we do our love for God. This reveals itself not only in the increasing concern of churchmen and missionaries for the physical well-being of their flocks, but also in their attitude to those of different beliefs, for all men suffer, whatever their ideals, from the same physical and psychological weaknesses and need the same kinds of care. The benefits which flow from this concern for our fellow men are great. We are more tolerant of personal weakness, more intolerant of impersonal exploitation. We are more humane in the best sense - and we recognise that a man's well-being can affect his spirit: that while it may be hard for the rich man to enter the Kingdom of H eaven,

WALES

Llandrindod '73

THE FIRST residential weekend course for young adult members (16 to 30 year olds) was held at LIandrind od Well s recently, attended by 100 mem bers. The conference was opened by the Chief Commissioner for Wale s, Lt. Col. J. R. 1. Traherne , and the Chief Training Officer for Wale s, Mr. J. P Harri es, planned a motor disaster involving two vehicles, two cyclists and a bus queue, with 15 casualties resulting. Members of the course took part as first-aiders,

A casualty being treated at the scene of the

extreme poverty makes intolerable demands upon the individual and may stunt his spiritual development.

In an age like thi our Order shou ld flourish. From the II th-century th' Order of SL John has been a part or that wing of Chri tendom which has expressed its ideals in practical action. 1l has consistently preached the surrender of self to the service of others and it has committed its wealth at a time when it was extremely rich to the care and protection of the sick and the defenceless. In those centuries in which for Christians devotion took precedence over charitab le activities it remained an adherent of that sca e of values which are nowadays admired. Few organisations or orders in any church have quite the strength of its traditions.

But it should also be recognised that present attitudes can, jf exaggerated, lead one onto perilous ground and this is demonstrated, it seems to me, in the views on church government and old-fashioned piety occasionally

rece ption cen t re a Lten dan ts , casualtIes and simulators.

On the Sunday there was a servIce conducted by Canon W. Davies, Rural Dean, followed by a demonstration of inshore rescue under the direction of Commander C. Thompson, Director, National Coastal Rescue Centre. Taking part in the demonstration were the Ferryside, and Lough or In shore Rescue Divi sions, Barry Lifeguards Divi sion and Cardiff Mobile Division. The demonstration took place on Llandrindod Lake , in beautiful spring weather.

Sunday afternoon was devoted to members discussing the future of the Brigade in Wales.

Eve r yon e see m edt 0 e nj 0 y Llandrindod '73.

expressed by trendy churchmen. The real danger lie s in divorcing from one another the two commandments of Christ in seeing the relationship of man to man outside the context of the individu ,ll relationship of man to God. When man 's concern for his neighbour coml's to exist for and of itself without reference to his dependence on his Maker then, while it may remain of some worth, it ceases to be Christian. It is emascu lat ed from a religious point of view and rests on weak foundations, because it has repla ce d the objective and immutable with what is, of its essence, subjective and shifting. And it is here that the Order of Sl. J ohn has such strength. Being a religious oreler with specifically religious terms of reference, it cannot ignore God and cannot absolve itself entirely from devotional duties , because if it did it would cease to be Built into the rules and at the heart of the structurl' of every branch or the Order there lies a recognition of dependence on the Divine Will, providing a backcloth to all the chantable work. It IS, therefore, not only well suited to take advantage of present Christian aLLitudes: it also provides a firm anchorage in times of stress and doubt.

Conference

The 2nd JOlllt confcrence \\as held at Cardiff on Sunday, 13 \\ Ith the Chief Surgeon for \\alcs, Dr. L R. S. Robcrtson. as chalfin an.

The ChicI' CommiSSIoner for \Vales, Lt. Col. J. R. L. Trallerne opencd the confercnce. and the guest spcakcr \\as Mr. Peter London , 1\1131, FRCS, Birmingham ACCIdent llo'lpllal, \\ ho gave an IlIu,traled lecture on the gcne ral VIC\\ of accidcnt scrvices with parllcular refcrL'nce t o the rolc of thc GP. The Nursing Ofriccr, \If R. I. Thomas, of the Neuro Unit, Mormton Hospital. spoke of the ro le of in dealing \\ Ith thc long stay unconscIous patien L.

The prc-eo nference din ncr was held on the Saturday evening, and as a result or lhls successful confcrcncc plans arc now In hand tll hold a wcekcnd co urse In J 974.

Wales' C a det of the Year 12 year old Annette

OVERSEAS

MALAYSIA

The King of Malaysia (The Yang Dipertuan Agung) recently decoruted Mrs Mary Rose See with the Ahli Mangaku egara medal for her long service to Sl. John Ambulance in 1alaysia. Mrs. Sec, who first joined SJA as a nursing member in 1950, is now Acting Brigade Secretary :1t lleadquarters, Kuala Lumpur.

In 1968 he made a 6-week tour of Australia to study all aspects of SJA Australia In 1971 she attended the officers' conference in London. And she hus just returned from ew Zealand, where she accompanied an ambulance team competing in the open cilampion, hip

Mrs. See was awarded the St. John Long ervice medal in 1960 , and became a ServlI1g Sister in 1966.

The King of Malaysia was recently made Knight of Grace (ASSOCIate) of the Order of Sl. John.

The nursing team of Caersws Division (Mone) were first at the Welsh Brigade Finals, held recently at Cardiff, a nd will represent Wales in the London f\lational Fin als

Glamorgan's SJA Loughor celebrated their Jubilee in May, when their rescue launch was inspected by the former Chief

sta ble of Wales, Mr. Melbourne Thomas

News from the Divisions

OBITUARY

ALFRED C. STOCKS, founder member of the Bounemouth Transport \ mbulancc DiVIsion, with 40 years servicc. died recently at the age ot 60. Serving Brother.

Anatomic Anne

Training manikin unit with details of upper airway trachea, left and right b ronchus and Inflatable lungs. The unit visualises blood circulation and lung action dUring correct CPR procedure.

Resusci Folding Bag MK II

Available with exclusive tran sparent Laerdal Masks In two sizes. Meets the highest standards for effective ventilation (no orwa rd or backward leak) and ease o f operation. Una ff ected by long she lf life, easily cleaned and sterilised.

Recording Resusci Anne

Automated. advanced manikin, immediately signals acceptance or rejection of CPR technique employed and provides documented evaluation of performance Diagnoses pulselessness and dilatatlon/ constriction of pupils.

laerdal Pocket Mask

Ready for use In 5 seconds, for effective ventilation, yet aVOiding mouth contact. Provides leakproof seal around mouth and nose of victim. Supplied In handy pocket S zed case.

laerdal Jet-Suction

Self-powered unit specially designed for emergency oropharyngea I suction. BU lds up a high vacuum In seconds, with constant suction. Operated Instantly, leaves operator's hands free, uncomplicated action. lig h tweight and compact.

laerdal Modulaide II

ComprehenSive, compact first aid and resuscitation kit. Contains the RFB MK II, oxygen reservoir tubes. laryngoscope, and al l equipment necessary for Immediate emergency use. ProvIsion for storage of drugs, syringes. etc.

THE THRILL OF AFRICA

In the heart of Berkshire!

laerdal

Vacuum Mattress

EspeCially useful for transport ng patients Involving spinal Injuries. Mattress filled With shock - absorbing plastiC balls, and when air IS evacuated prov des ri g d support and Immobillses Injured areas

Vacuum pump IS stored In one of the carrYing poles.

HUNDREDS OF ANIMALS ROAMING WILD

laerdal

Suction Unit

Lightweight. rechargeable. battery operated portable suction unit. Can also operate from 12 volt ambulance or car battery, or mains AC. supply. High vacuum and liquid displacement, full vls)ble control, no overflow problems, easily sterilised.

laerdal Disaster Kit

F-ully comprehenSive emergency equipment contained In separate , portable modules for specifiC purposes. Includes ventllatlonsuction -intubation equipment, bandages. Instruments, drugs, and InfUSion.

EqUipment case made of glass fibre, ImpervIous to climate, and can be carried by one or two persons.

Write to us for details of special party rates. Combine education and fun at Royal Windsor Safari Park Windsor Berkshire S L4 4AY 6984 i

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are Interested. to - Vickers Limited. Medical Engineering. Priestley Road. Baslngstoke. Hampshire. RG24 gNP

SEE

Lions, tigers, rhinos, zebras, giraffes, elephants and many more. Meet Ramu the Killer Whale and the playful dolphins Visit the new Reptile House with its crocodiles, pythons and iguanas!

It was no accident St John chose Guildway.

St.

A

As

RAISING SUCCESS STORY

ST. JOHN REVIEW

AT RANDOM

by Watkin W. Williams Deputy Commissioner-in-Chief

'SARAS HAD TO SW I M at least fifty yards in rough, sha r k-i 11 rested sea, hampered all the time by a strong backwash. She showed great presence of mind and courage beyond her years; of some 200 spectators on the beach she was the only one who ventured into the sea in a rescue attempt, and this she did twice with no thought of her own dangeL'

News

News

So runs part of the citation submitted by the Priory for South Africa recommending the award of a Life Saving Medal to liss Sams Manilal, an 18 -year-old nur ing member of the Senior Indian ursing Division at Pietermaritzburg in ata1. The victim was a man of 32 who , while bathing alone last December (which is mid ummer in atal) , was knocked over by a large wave and wept away by the very strong undertow in full view of his family. Having at the second attempt managed to bring the victim's body to the beach, Saras instantly tried mouth -to-mouth resuscitation but without uccess. It was later established that death was not due to drowning but probably to a heart attack sustained at the moment of impact by the wave.

The Life Saving Medal of the Order in Silver has recently been awarded to Saras for her most gallant action performed in the highest traditions of the Order, which will be a source of pride and inspiration to the fellow-members of her Division and indeed to all St. John member everywhere.

Northern Ireland

Following close upon the news of this award came the further news that Her Majesty The Queen had awarded the Brjti h Empire Medal for Gallantry to Sergeant Hayden Elliott and ursing Member Mrs Kay Blankley both of the Headquarters Transport Ambulance and ur ing Divi ion, Belfast for their gallantry in rescuing, under fire , a youth of 16 or 17 who had been shot in the abdomen and thigh during an occasion of mob violence last year.

Mr. Elliott and Mr. Blankley had to run through a hail of missiles thrown from both ides to reach the ca ualty. They dressed his wounds under a further hail of missiles and de ultory shooting, and then with the help of a bystander , carried him some distance to the ambularlce; during their journey they were exposed to further throwing of stones and shooting, their only s lender protection being a single riot-shield carried by a soldier. Their citation tates that they behaved WIth absolute calm, a most exemplary devotion to duty and a complete lack of concern for their personal afety.

This is but one further example of the splendid work being done by member of the Brigade in orthern Ireland much of it inevitably passing almost unnoticed - performed with total

AT RANDOM (contd.)

lack of sectarian or political discrimination for all victims of violence and accident, and with no thought for the personal safety of the first-aiders It must surely make us all very humbly proud to be fellow-members in the Brigade with such people as these.

POW Certificates

During World War II my friend Reg Granger wa a POW in Stalag XXA in Poland and was active ly e ng aged in providing occupational therapy for his fellow-prisoners. Being a qualified lay instructor of the Association, one of the things he did was to run Association first aid courses in the camp, and he managed to get in touch with St. John HQ to obtain official recognition of these courses and of the temporary certificates issued to successful candidates (including himself!). He has recently very kindly given us his own certificate, illustrated here, and writes: 'The spelling must be forgiven as it was done by a Poli h printer in Thorn (the home of Nicolas Copernicus) and there was no chance of getting proofs to check.'

First Aid Certificate.

This IS 10 ccrll\'Y Ihill (Q MS

P. O. W. No. Mnty 1\'0. ",/'077(3 has completed

a coursc of instruction and passed an l'.\nl1lination In First Aid to the Injured, at thc standard ,el by The Order Of 5t. John of Instructors -.e " G( ,i'uJ-Y: /'f!(Ji.- .l.G.M.C

Signaturs St,t1ag XXa Date

POW first aid certificate

did my best, after the war, to en tice him to become a member of the Brigade division of which I was superintendent; but his professional and family commitments, in addition to Civil D efence membership, made this impossible. He was, however one of our most valued supporters and regularly attended our Brigade-sponsored Association courses to maintain the validity of his own certificate.

Splendid June

What a splendid month of June we had, despite two or three brief torrential downpours! J think the roses have never been more lovely, and for once the serried banks of glorious yellow St. John's Wort were in full bloom in good time for S1. John 's Day. Four consecutive weekends involved me in four very different functions, each of which included a service in honour of our Pa tron Sain t.

First, a drumhead service on Putney Common where I had the pleasure of meeting and inspecting a fine parade of 800 members of the South Western Area of London District; then the annual service of the S1. John Council for Essex at the Hospitallers' church at Little Maplestead, one of the five churches still surviving in England which have a circular nave, modelled OIl the church of the Holy Sepulchre in Jerus alem; then the Patronal Festival Eucharist on St. John 's Day (a Sunday this year) in my own parish church at Epping, attended by local members of St. J ohn Ambulance and the Red Cross who joinlly formed the offertory procession; and finally the annual Commemoration and R e-dedication Service of the Order in S1. Paul's Cathedral, at which we were joined by representatives of the Sovereign Military Order of Malta and of the Alliance Orders of S1. John. It was a special pleasure to have with us at the General Assembly and Commemoration Service this year so many 2

St John's

PERFECT WEATHER FOR THE

ANNUAL SERVICE AT ST PAUL'S

DayTHE ANNUAL commemoration and rededi ca tion service of th e Order of St. John was held in St. Paul's Cathedral on the afternoon of June 30 1973

More than 2,000 members of St. John Am bulan ce, including over I 000 in uniform from all over the U.K and frdm a dozen o;erseas countries, as well as 30 s pecial cadets selected for outstanding service during the previous year, attended.

The Lord Mayor of London attended in state and the preacher was the Rt. Rev Kenneth Riches DD , The Lord Bishop of Lincoln Banners of the Bailiffs Grand Cross of the Order, which are hung in the Grand Priory Church of the Order in ClerkenwelJ, are taken down on the death of a Bailiff. This year the ceremony of the Removal of the Banners of the Most Rev. and Rt. Hon. The Lord Fisher of Lambeth, sometime Prelate of the Order and Lord Archbishop of Canterbury, and of Dr. Richard Williams FSA a former librarian of the Order, was the St. Paul's service.

St. John overseas was represented by members from a dozen countries

representatives of the Priori es over ea , as well as of \V,lieS and Scotland , who had assembled for the meeting of the Grand Pri or's Advisory Council (held once every four or five whIch too\.. place the following week. It was also a wonderful trIbute to the work of the Order and its Foundations that the Lord MayO! should not merely hav e twice mad e u s hi s guests ut the 'V1an slon House, but also devoted to us a whole day of his tl111e, and another evening, all during o ne weekend. H e attended In s tate the General Assembly of the Ord e r at the Man SIOn Ii ouse on the last Saturday morning of June , and the service in t. Puu 's that same afternoon; and on the following Monday eveni ng he most generously gave a recepti on at the ManSIon H ouse, in the gracIous presence of Her Royal Highne s The Prin cess Anne, on the occasion of the first vi ewi ng o f K enneth Green's beautIful portrait of Her Royal Highn ess in Brigade unif or m and wearing the mantle of the Order. It was an unforgettable occusion for a large number of St. J ohn repre sentat Ive s from at home a nd overseas who had th e immense pleasure a nd privilege of ,>el' lng meeting and talking to Princ es Anne during the cou rs e of the evening.

In mid-Augu s t it will be my good fortune to se out on a round of visits to St. John Ambulan ce In so mc of the coun tri es in Eastern and Southern Africa I'm immensely lo o king fo rward to renewing some old friendship s and making many n c w ones; and when [ return at the beginning of October I shall hope not to find too heavy a backlog of letters to ca tch up with , and will try not to keep my co rrespondent s too long waiting for answers! And I shall hope to share with you some of my expe ri ences through the medium of this column in the O ctober and November issues of the Review.

AT THE MANSION HOUSE

A £ Y2 -MILLION appeal for the Order and its Foundations was launched at the City of London's Mansion House on July 2 when Princess Anne attended a reception at which a new portrait of herself wearing Brigade uniform and mantle of the Order was on view. (See cover). The portrait, painted by Kenneth Green, was commissioned to mark the Cadets' Golden jubilee Year (I 972). Princess Anne is of course Commandant-inChief of the Cadet Divisions. The reception was attended by the Lord Mayor and Sheriffs of the city, as well as leading figures from business and industry.

12-year·old Alexandra ngl is, jun ior cadet, of the Guildhall Nursing Cadet Division presented flowers to Prin cess An ne the Lady Mayoress and Lady Caccia

(Photo: Bar Swaebe)

The Lord Prior Lord Caccia, and Lady Caccia, on the steps of St Paul's flanked by nursing members and cadets

Superintendent- in·Chief Lady Moyra Browne followed by the Chief Commander Sir William Pike

Presto n (Lancs) You t h N u r sing Cadet team, who finished 4th, brought along their mascot to meet Princess Richard

Netherton (Worcs) Nursing D,v,s,on 's team working methodically to finish 2nd

Brigade Finals

48 TEAMS COMPETED AT FAIRFIELD HALL , CROYDON, ON JULY 7

BLU SK I ES, plenl) of 'iLlIl, 4?S \cums I--een to stMl, and P rince Richard, (\)J1lmandanl-in-Chll'f J\m\1ubnce Corps and Dlvi-;Ions, ,Ind Prince'i'; Richard :Jrriving al Croydon by hL'llcopter lo .Ippl':lr in public for the first lime in St John uniforms (July 7 W:J, also their weddll1g by lllL' W,I)-) tIm was Brigade Finals 19 73. Lasl ye:Jr, when SecrL'lary 01 Sl.lte for SOCial ,ervil'L's ir Kl'llh J {)seph prL'sented hL' a\\ ards, hL' L'>,pressnl much IntL'resl in thL' wc lfclre of St J ohn worl-- Jnd lakr pil'sented a Irophy, thl' Sir K eith J oseph Cup, for a welfare cOlllpetltiGn. \l this Yl'ar's finals I\liss Gribble, of London District, W,IS busy demonstrating how such a we1Lne cOllllwlltlon Sl't cou ld be slaged. No deciSion has L'l bel'n Illadc Oil this new compet Ition.

RESUL TS

Ambu la n ce l arb (max. 400)

1st: hrL' 131 317 '_

De\\ar Shield, -Ilis CLIP, nlllbk Shield

2nd: Boisowr ( Derb ys I 30\) Symons r cclcs Cup

3rd: Nalional Dod lub uLiI RO.lrd (London)304 ong K ong SIlJ(:,lcI, Illng stoll Ruse Bowl

ursing

hl: St. \iarychurch (Devon) 305 " Perrot Shield, i\10unl bal len CLIP, ;>,1uLllllga rrL'l Cup

2nd: elherton (Worl's) 2t)5

Corhelt fletcher Cup, ChdlJ11L'rs SlllL'ld ElliS Cup, ColdJI1g Tro phy

3rd: & Di sl Combllll'd (\\I,lks) 2XO

SlL'wa rt Cup

A mbu l ance Cadets

lst. Babblnglon Co\llL'r) ('..otts) 322

Whil l: Kn ox Cup, LlrVIS CliP, CUjl

2n d Kldlingl on (Oxon) 290

Schooling Cup, ew ZL',i1,llld CLIP

3rd: Gl Yarmouth \ 'lorlol\...) Pownall Cup

N ur sing Cadets

1 sl: Clayhall (London) 2XOIl

Dun bclr-NLI,)!l1it h Cup, Clinard Cup (IlL') hnd oll Cup.

2nd: Tho rl:sby Colliery (Notls)

Mounlbat lL'n CUjl

3rd: LL' yLlnd Combined (L clnc,,) 270

Pownall Cup, Whitl, - Kn ox Indi Vidua l Cup, \3edmaking Cup (lie)

Drownin

THE TE R M drowned means more than ju st the distressing situation of having been in water and unable to have kept afloat; rather, it means that a person has died as a result of having been submerged in water. Death may not occur until later, after the subject has been apparently saved in which case the terms delayed or secon'da r y drowning may be used

The first-aider has a prime part to play in preventing death from drowning, and this treatment is well explained in the manual. This writer has ha d cause to officiate in two such disasters during the last four years when he was present by chance , once in a public swimming pool and once at the seaside; thus, the likelihood of the first-aider being called up on to treat someone who has been drowned is relatively high, and the techniques involved should be practised regu l arly. For these to be successful, no deep understan d ing of the processes involved in drowning really necessary but in order to add interest and understanding of the sequence of even ts, so m e explanation may be welcomed.

Im m e r sion in water kills in three ways: by exposure following inhalation or rarely, by reflexly causing the heart to stop.

Exposure

I f the water is cold , even though the in d ividual may swim well, a situation can occur in which, despite physical effort, he is unable to generate sufficient heat to maintain his body temperature. His temperature fails and a state like hibernation soon occurs, in which all the metabolic chemical processes slow down. He g oes to sleep. In addition, because the hu m an b o d y is not designed for these con d itions, some chemical processes change and the balance of substances d issolved in the bloodstream and cell fluids becomes disturbed; the heart ceases to beat properly and the subject dies. This process is precisely the same as death from exposure, as may occur in extremely co l d weather, and is not true d rowning unless, of course, when sleeping his head goes under the surface.

True Drowning

In primary drowning , the conscious 6

IS LI KELY TO INCR EAS E IN F R EQU ENCY

AS PEOPLE HAVE MOR E LEISURE T I M E AND INDULGE IN AQUATIC SPORTS

BY R. A E son, M B, FRCS

individual is unable to keep his head above wate r. He holds hi s breath until the last moment and th e n u s ually com m ences to swallow water. This is partly reflex and partly an effort to relieve the discomfort of the intens e desire to br ea the. The reflex involved occurs because as soon as the minutest drop of water touches th e vocal cords, thes e come together tightly and prevent water in quantity getting int o the trachea They remain shu t until the sub j e c t becomes unconscious from asphyxiation , and then only do they relax, allowing water to e n ter the lungs

Once in the lungs, wat e r acts as an irritant, causing inflammation of the alveoli. Also, the nature of the water influences subsequent c hanges which must supervene in death ; fresh water seems to be more lethal than sea wat er since it is absorbed very rapidly into the bloodstream and disturbs the balanc e of the chemical constituents. Se a wat er, on the other hand , being a more concentrated solution of salts than the blood , attracts water through the alv eolar

membr ane an d dessicates the blood , making it m o re co ncentrate d and thick ; as a result, th e heart cannot pump it adequately and it fails. The laLLer death from heart failure takes lo ng er than the failure from water an d e lectro l yte disbalance, which results from freshwater inhalation, probably four o r five minutes.

Whatev er the mode, circulatory failure causes irreversible brain damage if not correcte d within about three minutes

During the period of unconsciousness, if the subject recovers, he m ay remember dreaming , so m etimes his li fe se quence , but if, whil e stil l conscious, he gasped-in water, he may remember the acutely uncomfortable choking sensation in his chest.

A s in other cases of irreversible brain damag e from failure of the c irculation, if the subject recovers , it is possible that he may s u ffer from per man ent mental impairment. In practice, however, most patients who survi ve from drowning , a lthough they may have a temporary period of a brain disorder such as fits

Sequ en ce o f E ven ts in True D rowning Subject submerged

Water enters mouth or no se and irritates lary

Reflex clo sure of vocal cords

Asphyxiation (much water swallowed)

Unconsciousness

Vocal cords relax

Water enters lungs (sea water or fresh water)

Circulatory failure

Irr eversible brain damage and death (PRIMARY DROWNING)

1-------- ---- Pneumonitis

Possible death from respiratory f ailur e (SECONDARY DROWNING)

conrusion or unconsciou sness, do not remain permanently di sabled mentally. This is bcc;)usc , in th ose cases in which water enters the lu ngs, the dumag e which results to the a l veolar mcmbrane fr o m innammation rc s ults in pncLimonia <lnd thi s m<lY prevent re cove ry Pneumonia (pn CLi 1110 nit ca uses m<l rked thi cken ng of the alveolar memhr<lne In <III the alveoli <lnd tili s ma"es it diffi c ult ro r oxygen to pa ss across inl o the hloodstream Therefore lack of oxyge n, initially ca tl se d by failure to breathe, is co ntinued and uncon ciousness and subseq uently respir<llory f<lilur e supervenes.

Sometimes, water is inhaled <lcci d cnta ll y an d this ca n cause thc on ct o f pncumonitis and seconda r y dr ow ning , although the subject may never have be en OLit of his dcpth and drowned In the conventional sc nse.

There arc many variations on thi s train o f events' for example, if a person uslalns a blow on the head and then falls into water, he may be uncomcious a lr c8dy Jnd straigh t a way inhale w8ter.

Reflex Heart Failure

Fil1:1l1y , there i s :1 rar c occurrence in whi ch inha l <ltion of a littl e nuid , even a cup of tea, ca n renex ly stop the heart and rapid 10 s of con ciousnes and circulatory failure occur. This co uld cause tru e drowning if the sub ec t we re

Visiting HQ

s wimming at the time. It s hould be clear to th e first-aider that the urgent clearan ce of the airway by positioning the su bj ect with the head l o were d is th e fir t vital step in resuscitating a drown e d person. Copious qU<lntities of swa llow e d f1uid may w ell up fro m t he s toma c h and this may co ntinuously e mb arrass the airway even after re-e sta bli s hing br ea thing. Having s tarted artificial respiration , attention must be directed to heart function and ex t ern a I ca rdia c massage may be

J I. E. 1\ l r<, Gowon, while on a visit to Britain with General Gowon, H ead of tate of igeria, visited SJA London headquarters on June 13.

Mr s. Gowon, who is a lralned nurse, wa<; welcomed at Grosvenor Crescent by the Chief Commander Sir WIlliam Pik.e an d was presentcd to seni or m e mber s of S JA

I ncJuded 111 the visit was a showing of th e film A Way of Lif e, aboul the work. of St. J o hn, and a discussion, led by L ady Moy ra Brown e, th e Superintendent-in-Chief , on the parl women can play in SJ A work.

With Mr Ojeriahki, who is from Nigeria, but on 6 month training cou r se with SJA in Britain

nec essa ry if ca rdia c arrest or failure has occurred. Finally, anyone who ha s b ee n nearly drowned shoul d be taken for medi ca l attention for, while the onset of pneumonitis may be delayed, it may nevertheless prove fatal later.

Drowning is likely to increase in frequency as people have more leisure time an d in dulg e in aquatic spo rt s Many thousands di e from this acci d ent each year. The first aid rendered is the most likely treatment to save the life of the drowning man, woman o r chil d

Mrs Gowon with the Director Overseas Sir Hilton Poynton

PR

Dealing with the news media - press, radio and TV - is a very important aspect of an organisation th at depends o n publi9 goodwill for its existence. St. John is such an organisation. Whi c h is why our newly-expanded public r e at ons departmen t (which also covers n a tional fund raising) at HQ dire c ted by Ge off Meek, has issued a bookl et A Guid e to the News Media.

How to d ea l with press , radio and TV is very simply but effectively exp lain e d in t his booklet , and its second h alf d eals with fund raising (with one section on how to mak e mon ey which I'm still studying) - whi ch is the natural outcome to successful public rel at ions. In o th e r words , people will only 'co ugh-up wh e n they really und e rstand and app re c iat e what a n organisation is doing.

Every division should get a copy of this booklet and study i t , then tryout its suggestions and advice ; from the Publi c Relations Dept , Order of St. J oh n, I Grosvenor Crescent, London SW 7EF Free, of course.

VINTAGE SJ

I hear that an ambulance in the livery of the Brigade was one of the hundred or so vehicles which went to Austria during July for the Rolls R oyce Enthusiasts Club's Alpine Rally to commemorate the crossing of various high Austri a n passes sixty years ago by three Rolls Royce Silver Ghosts.

The ambulance , a 1929 Phantom II , registration GC 2153, is privately owned by London solicitor Mr. G. C. Docwra J ones, who is confined to a wheelchair as a result of polio. Because of his disability he bought the ambulance in 197] after a long search for a suitable vehicle to accommodate his wheelchair and b.reathing e q uipmen 1.

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST . JOHN

BY THE ED I TOR

The driv er on the rally w as Dr. Geoffrey Spenc er, co n s ultant in charge of the intensive ca r e unit at St. Thomas's Hospital

The long wheel b ase chassis of GC 2153 originally had a land au l e tte body d e sign e d to seat six o r seven people.

Some six m on ths after it was first registered in 1930 it went to a Broadway address in New Yor k, but r eturne d to Britain in 1936 when it was bo ught b y a Sheffield industrialist.

Th e land a ul ette body w as r ep aced by an ambulance body by H er b ert L omas Ltd ., of Man chester, a nd a plaque on the vehicle indicates that it was presented to the Brig a d e in 19 40 by the Sheffi e ld Working Men 's Club. It appea rs first to have g one to th e So li hu ll Ambulan ce Division, Warw ckshi r e, but ultimately it be ca m e the property of the S kegness Division in whose hands it remained for a bout 20 years.

In 1970 it wa s acq uir e d by a Linc o ln shi re d ea er, wh o so ld it the following year t o it s present owner. Mr. Docwra ] ones has r esto r ed it to excellen t con dition but at the same time has

APPO I NTMENTS

Camb s: Dr. H M. Weaver, Area Comm. P eterborough and Hu ntingdon, to Shadow CS tJ A Cam bridgeshire.

Cheshire D r. A G lI ick to County

Surgeon , vi ce Dr. J ean Millar.

Durham: Mrs F. M. Ow ens to County Supt. ( ).

Hong Kong : Mr H K eswick t o be Cha irm an, St. John Council, vice Sir K en n eth Fung

retained as much as possible of its origll1ul appearance wllen it first became a St. J ohn ambulance.

GOING UP

37-year-old P hilip J Player of [I itchin, who join e d SJA at L etchwo rth in September 1947 as a n ll-y ea r-old ca d e has been appointed area com mi ssioner for H ertfordshire northern area the first cadet-to-areu-commis o n e r in the I [erts command.

A Grand P rior ca det a nd S erving Br other in the Ord er, Mr. Pl ayer was for some years the divisional s up eri nt e nd ent of the Hi tc hin Ambulan ce Cadet Divi s ion In 1969 h e was promoted to a r ea staff officer - ambu lance cadets, a post he held until 1971 when he b ecame urea s t aff officer (ambulance) A s s u ch he was directly resp ons ibl e to the area com mI ssIoner for a ll the amb ulan ce divi s ions in the western area of th e cou ntr y.

Th e St. J o hn tradition is strong in the Pl aye r h o use h o ld Mr. Pl ayer met hi s wife, Ba rb ara, when they were bo th ca d ets a Let c hw orth, and hi s two daughters, Ch ri s tin e, 12, and D eborah, 10 , a r e member s of the H itchin Nursing Cadet Divi sion.

EGG - H EADS

r hear w e have tw o budding and ve ry a ttr active sc ienti ts in our mid s t P at ri c ia Rudg e, 14 , a nd K ay Atkins o n , 13 both sergea nt s of L e ices er's Vaughan College Nurs in g Ca d e t Division. Wit h friend Elizabeth Allen , 13 thi s e gg-h eu d

trio recently became joint winners of" the Philips 5th Y oung Scientist') of the Yeur contest for their stUdlC on th e effect of food and diet on migrulOe sufferer and whether certuin acids in food can bring on un attack.

their <;chool, Leicester's Alckrm.lI1 ' ewton Girls' School, en tered the trio for the local Polytechnic Science Fair, from which they were one of three teams chosen to enter BBC/TV'<; young <;cientlsts of the yeur contest. They finished second in this contest to u boys' team from Neath GrClmmar School, who were studY1l1g runner beun blight.

These t wo were chosen to represent Britain in the International young sCientist of the year contest, which took place at the London Science [ useum during \'luy, with 30 other entr ies from throughout Europe.

Pat Kuy and Elizabeth were joint winners of the contest, collectIng (500, with from Fr unce, Ital y and Luxembourg.

As my photogruph shows, the) met Pnn cess Marguret at the opening of a migraine c lini c in London's Churterhouse Square recently.

We hope to pub ish some of their studie on migruine in a future Issue of the R eview.

HOW IT'S DON E

Wh en, in Oct ober 1971, a Ryd e tailor retired and offered his shop free to the ladies of R ydc Ambulance DiviSion for a few weeks for fund raising, their c h uirman's dreum not only becume reality but went beyond the wildest flights of imaginati on,

Eight ludies (wives of members) formed th emse lv es into the 'Ryde St. J ohn J\mbul u n ce Supporters', und opened a Bargall1 hop. The qUick re'ults al11aled eve n th em!

Ellcouraged by thi s initial succe s, the chu irman negotiuted with a local firm for th e u sc of unother empty s hop to continue the venture after the first s h op had to be returned. On hearing t hat it was for St. J o hn Ambulan ce, the ow n ers agreed to let t he s h op for rates and li ghting expen es o nly. The Bargain Shop

Egg Heads

Egg hea d s (L to R)

Elizabeth, and cadets

Pat and Kay meet P Inc e ssM a r gar et because of the success of their mig aine studies. See sto ry EGG HEADS ( P hoto; P ress Association)

was a dv ertise d continuously in the local paper, as was an appeal for unwanted clothing, crockery, toys anything saleable in fact - for the shop. The public responded so well that there was soon a continuous flow of goods for the shop. Everything was carefully sorted and price d, while sub-standard goods were offered to other o rg ul1lsation for jumble sa les.

Worki n g a r ota, the eight ladies, wi.th the help of one or two volunteers, kept the shop open five days a week. After five months they had to give up this shop as the owners needed it. The chairman hunted around for new premises, which was again offered free of rent to St. J ohn Ambulance and the supporters were back in busine, s. Th e Bargain Shop finally ca m e to an end when thi shop was old.

Altogether the R yde SJ A Supporters ran their Bargain Shop for 16 months; not long, you may say, but in that time they raised £4.0:24.67! R esults of this work and enterprise can now be <;een in the headquarters of Ryde Ambulance Division, a hall 30ft. by 40ft., with offices, which had been getting very dilapidated until .the supporters banded together. They had a uspended ceiling fitted 111 the hall, modernised and fitted out the kitchen, had large s tor age cupboards built for diVIsional equipment, and the interior and exterior of the entire building redecorated. Th ey have also supplied the division with a 16mm sound projector and a copy of the film 'Don't let him die', umform raincoats for the am bulance members and a new Re susci-Andy.

The supporters also supplied uniforms

800 on Parade

t o al l the ca d ets in the newly-formed Ryd e N ur si ng Ca d et D ivision, and had the Co unt y H eadq u arte r s at Wootton

r e d eco ra e d A n d t hey still have, believe it or n ot, a b al ance i n h a nd to m eet some f utur e nee d !

Th e m ora to this story? If you want to get ahea d , get a Supporters Club

pr efe r a bl y 8 la d ies such as those who live in Ryd e, I sl e of Wigh t, off the so u th coast o f England w i th a chair m an who d oesn't und ers a nd th e w ord no.

THE

LAST

On Jun e 2 4 a b out 1200 SJ A members

fr o m ev e r y area in South Staffordshire

m a r c h ed to Lichfiel d Cathedral for the l as ch urch para d e and enrolment

ce r e m o n y which they will attend there.

Fo r n ext year a lm ost the whole of the so uth e rn a r ea of S taffordshire will

church of the Good Shepherd, Downham, on the Feast of Corpus Christi, in the p resence of a very large congrcgution. Severa of his fellow students assisted at the Mass with the R t. Rev. Victor Guazze li Auxiliary Bishop of Westminster , who performed the ordination ceremony. There wa s an almost full turn-out of No 305 (Bromley) Combined Division, under Superintendent Ray Saunders, most of whom were old friends of R chard.

An ex-cadet, Richard had given constant help and encouragement to the two Bromley cadet divisions. Before he left, he ·presented a nag to C. .61 Division, and a flag party of nursing cadets from the Division paraded the flag which was laid up at the allar during the Mass. After a short holiday, Father Wakeling will take up his duties in a parish in the Westminster Archdiocese; and hopes to resume his active interest in the Brigade.

TYPSY CAKE

become part of the new West Midlands Metropolitan Area, while Lichfield will remain part of Staffordshire.

160 new mem bers were enrolled at the Lichfie l d Ca thedral ceremony.

ORDAINED

On J une 21 an event took pla ce whi c h is probably unique in the history of the Brigade. Richard Wakeling, ex-ambulance member of London's Bromley Division, was ordained a priest of the Roman Catholic Church.

R ichard, an active and popular member of the division, left Bromley in 1965 to study for the priesthood, first in London and then Dublin. The Ordination Mass took place at his home parish

You'll find the recipe in this book

As well as cricket, brass, common- ense and a lot of other homely things, Yorkshire is renowned for its no-nonsense cooking, so 1 was rather surprised to find a SJ A book on my desk called The Yorkshire Kitchen which runs to no less than 110 pages of 'recipes o l d and new from York hire houses '. But there, they do say that we're only just beginning to discover England.

Spaghetti and paella forget it. Try some of these instead: llkla Moor pie; Yorkshire hot pot (the real McCoy); Yorkshire cobbles (\ thought they were small fishing boats); and if you're rea ll y feeling in the dumps what about a piece of Grandma'S typsy cake? I won't tell you what's in Grandma's special, but The Yorkshire Kitchen will, price SOp plus postage (1/2 copies lOp, 3/4 copies 18p, 5/6 copies 22p, over 6 copies 25p) from Miss Sugden, S J A District HQ, St. J ohn's H aU, Ki l1 ingha ll H arrogate, Yorks.

GIFT TO HOSPITAL

A photo-therapy unit, treatment of jaundice used in the in newly-born

distances and, if necessary, rest during the journey. Both aids increase the sense of mobility and independence and for many will reduce the need for sticks and crutches.

Both versions are finished in hard wearing white enamel paint. The Perching Stool has two plastic non-slip feet and the Perching Walker has [our suction rubber non-slip feet.

A list of stockists can be obtained from the manufacturers, Ellis, Son & Paramore , Spring Street Works, Sheffield S38PB.

FROM TH E BEACH

Society - has now won Thomas Nyman, of Salisbury, UK, where they're going to live. Anna was a very popular SJ member in Malta; I'm sure she'll be popular in Salisbury too

babies , was presented to the Elizabeth Garret Hospital , London W3, by o. 335 1I 0iborn A & N Division recently.

Members of the division had heard that the hospital needed the equipment, so set about collecting the funds outside the Brigade. The dlVi ion's president Cllr. Brian Duggan, the Mayor of Camden, was at the presentation ceremony.

NEW

The many thousands of people restricted by arthritis, partial di ablement and the frailties of old age may find comfort and assistance in two new aids, manufactured by Ellis, Son & Paramore Ltd ., which were introduced at the NA I DEX Exhibition & Conference, held at Brighton recently The Hayman Perching Stool and Perching Walker have been developed by the Royal ational Hospital for Rheumatic Diseases, Bath, and the Bath I nstitute of Medical Engineering, in conjunction with Ellis, Son & Paramore Ltd

The aids (photos right) are designed for use both by men and women in the home und working enyironments - in the kitchen or bathroom, at the work bench or in the office, on the same basic structural concept; a four-legged rigid steel walking frame to which a padded seat has been added. In both versions the seat is adjustub le for both height and r ake. Simple sp r ing loaded bolts make adjustment easy especially for pe o ple with arthritic hands.

The Perching Walker incorporat s the additional facility that the seat lift away so thut the u er can position himself to use it a a conventional walking frame.

The Perching Stool i de igned for use at a work bench or table where the user will spend u ot of time in one position or will only wish to move it short distances.

The Perching Walker is main l y for those who need a dual-purpose aid which can be moved about easily over greater

August seems an appropriate month to publish this poem by 13-year-old Grays, Essex cadet Jennifer Parker, who has contributed Lo the Review before. The poem has already been pu blished in the magazine The Essex Coun tryside. But I only hope the sea is not in this sort of mood if you are si lting by it.

T H E S EA

The sea, a swirling mass of the unknown, Roaming, searching vainly for a home On the bleak coasts of the sand-swept beaches. Wild und roaring, clawing at the stones, Tearing and rampaging, Heaving and rolling,

Dashing wildly against the rocks; Sending the white spray flying madly in every direction.

Showering and drenching, The unknown drifts on, Roving forever to the end of age and time.

* Quite evocative, Isn't it? Especially for me - I have a weakness for the sea, in aU its moods. But that wasn't the only reason for printing Jennifer's poem - I think it is very good. Plenty of feeling.

Anna Sciberras, DIO No. 2 Slieina (Malta)

NurSing DiVISion - holder of Grand Prior badge, Duke of Edinburgh Gold Award, and Aw a rd of Merit of the Royal Life Saving

(Left) The Hayman Perching StOOl, and ( R ight) the P erching Walker - two new aids for the partially disabled. See story NEW AIDS

USEandABUSEofDRU6S

ON OBESITY , THE AUTHOR SAYS: FAT COMES OFF A PLATE , NOT OUT OF THE AIR. HERE HE LOOKS AT DRUGS IN THE WELFARE STATE

I HAVE BEE ASKED to talk about the use and abuse of drugs by the lay public.

Inciden tally, I prefer in this connection the term medicines to drugs for the word 'drug' like that of 'love' has recently developed undertones as well as overtones. However much I hould apologise for my execution of it, I do not apologise for the subject of my talk for all intelligent people should be interested nowadays in the problem presented by mod er n medicines and particularly perhaps members of the S t. John Ambulance

There was a time in the 1940s and 1950s when the introduction of a new medicine was usually hailed with acclamation, and the public media press, radio and so on - were full of accounts of 'wonder drugs' and 'breakthroughs' in treatment. Indeed the therapeutic millennium seemed just abo ut upon us In more recent years the pendulum has swung in the opposite direction and medicines are apt to be regarded with the utmost suspicion, almost as a threat to the integrity of the human body and even to the structure o f society. B o th attitudes are equally exaggerated but in the present one of near hysteria about the dangers and abuse of medicines , about which I will m ostly be talking here, it is perhaps wise to preface my remarks by indicating the vast benefits to humanity that the use of modern medicines have conferred.

It is chiefly due to them that the average expectation of life of men a nd women in this country has increased since the 1930s by over 10 years; an d quite apart from their benefici a l effects on mortality s tatistics which are well documentated, the relief from suffering resulting from their purely symptomatic use, and the saving to the national economy in diminished morbidity - less time lost from work fewer and shorter admissions to hospital - is vast but more difficult to calculate. It has been calculated fairly accurately, however, that the saving to our economy resulting from the use of modern anti-tuberculous agents alone is about £55 milli o n a year, or nearly a third o f our bill for medicines under the National Health Service Young physicians nowadays, armed with the therapeutic thunderbolt s of J ove which the synthetic chemist has put into their - often very ungodlike hands, can 12

by Si r Derrick Dunlop

The SJA Medical COIlference 1973 \Vas h o n oLired b v this address by Sir· Derrick DLinl op, EA, MD, FRCP, FRCPE, "'ho was Chairman of the British Pharmacopoeia Commission and Chair· mall of the JlJinisrry of Health's Committee IIp OIl the Safery of Drugs.

have no idea what it was like to practice medicine when there was no insulin, vitamin B 12 for the treat m ent of pernICIOUS anae mia , su lph onamides, antibiotics, hypotensives, anticoagu ants, specifics for tropical diseases, potent hormones. diuretics and anti-convu lsants. As the result of the use of modern medicines the pattern of disease as we see it today has changed completely from the time when I was a young d octor. Most hospitals for tuberculosis and many wards for the treatment of infectious diseases have been closed or given over to the care of old people or bronchi tics. Y oung people between the ages of 15 and 30 se ld om die from disease nowadays; the chief cause of death among them is accident - mostly on the roads, the secon d most common is suici de and the third, a long way behind, is the comparatively rare group of blood disorder s the ac ut e leukaemias. The at mospher e and len gth of stay in our mental hospitals has been changed out of recognition by the use of modern psychotrophic m edicines those acting on the mind or brain. The great recent a dvances in surgery have mostly been m a de possible only by advances in che motherapy , particularly improved anaesthetic techniques. L astly the medical wards of o ur general hospitals are largely filled with people Just suffering from the natural processes of aging. evertheless, just as the old horse and buggy, though very slow, cause d few fatal accidents, wh ereas the modern automobile, though very fast, is a letha l instru ment so the old fashioned bottle of medici ne, ela bo ra t ely prescribed, meticulously compounded, elegantly flavoured and exquisitely labelled, though relatively ineffective was also co mparatively innocuous, wh ereas the modern medi cine is like atomic energy

powerful for good but also for evil. III health due to medicine has become a new dimension in the aetiology of disease. Perhaps up to 10 per cent of our patients suffer to some extent from our efforts to treat them. Our powers over ature in this a in other re pect have advanced so far that Nature seem to have become retaliatory and to be exacting a massive retribu tion. There are no entirely safe medicine which are effective, for unless a mediCIne is able to modify or repress biologIcal processes it will be 1I eless in treatment ; but if it has thi ability then It is bound to cause adver. e effect. from time to time. Those who say that nothing but the complete safety of medicines will suffice are demanding the impossible. The public that demands progress must be prepared for some risk. They have always, curiously enough, accepted the not inconsiderable risks of urgery to which some modern mpdicines are eqUIvalent in efficacy. They shudder at a death ra te of, ay, I in 40,000 patients dYll1g a the result of tak1l1g a valuable remedy (and which surgeon would not be enchanted with such statistics for the most minor operation?) but are complacent about the far greater risks of CIgarette moking or death on the roads

Y et if all medicine were pre ' cribed and used with propriety, skill and wisdom, and helped by senSIble Government controls, their danger would be minimised. It is dIfficult to know how far Government hould attempt to assume responsibilIty for their production and use without undue interference with the advance of scientifIC therapeutics, the well-being of the pharmaceutical Il1dustry which dUring the past 50 years has been chle fly responsible for chemotherapeutic advance and the cherished freedom of the doctor, dentist and veterinary surgeon to prescribe as they think best. In adequa t e legislation can prejudice public safety but excessive regulation can also be prejudical.

Apart from caffeine containing beverages like tea and coffee cups which cheer but do not inebriate the two commonest drug in the We stern Wor ld a r e nicotine and a lcohoL Smoking, particularly of cigarettes , is an unnecessary and toxic addiction a very potent factor in the causatIOn of

bronchitis, atherosclerosis of the cardiac and cerebra l arteries, peripheral vascular disease and cancer of the lung. Possibly no other single fuctor would be more beneficial to the public health than the abandonment of smoking. II is much more difficult to dogmatisc about alcoho the of all drugs so old that it was used, sometime not wisely but too well by oah himself. From time immemoriai Bacchus ha been the God of b lithene s usually maklllg glad the hearts of men' inhibiting their hyness und their social relationships. Yet if the VIctims of addiction to medicinul drugs number their thousands, those addicted to alcohol their tens of thousands und we all know the ill health, mIsery and social und domestic degradutions which Its abuse involves.

We have now another drug in fairly common use which like alc o hol is of no medicinal value. I refer to marijuana with its numerous synonyms pot', 'bhang' , cannabIS, Indian hemp, hushlsh and s o on. I t differs from alcohol in that its effect IS Introvertish rather than socially extrovert ish , the individual pa<;se s into u pleasant dreamy state llntram melled by his , ocwl respon<;lbilitles In large doses it sometimes causes violent and even maniacal behaviour; indeed the word 'assassIn' was derived from Some claim that those who smoke m<lnjuana are more prone to become 3c1dicted to hard drug like heroin, morphine or pethIdIne. It ma) Just he, however, that the ort of person who smokes marijuana will naturall} become interested in such d rugs, rather than that marijuana stImulates a desire for them. The question which is troubling many reople nowadays is whether Its use should be legaiJsed or not.

We will never get nd of smoking or

ulcohol, even if we wanted to get rid of the latter, and it seems a pity to introduce another drug of this kind, of no medicinal value and which is hallucigenic. Three blacks don't make a white. On the other hand we must confess that in some Eastern countries where hashish is used as we use cigarettes less organic damage seems to result from this habit than from smoking cigarettes or the excessive use of alcohoL Further, it is always undesirable to attempt to en force a law which is unenforcible. In this connection it is only necessary to recall the terrible damage done to the law in the USA by the attempt to enforce prohibition of alcohol; and it is not easy to enforce the law against marijuana. So the question of whether its use should be legalised or not is a difficult one to answer. One sometimes envies those who seem to know at once what is right or wrong when confronted by any controversial problem : they are the people who do most good in the world and the most harm. Perhaps the more clvilised attitude is to be conscious of how much there is usually to be said on both sides but carried to extremes thi may make one like that wretched a<;s which starved between two bundles of hay because it couldn't make up its mind whether to turn to the one on the right or the one on the left.

The most striking abuse of medicines b) the publlc in recent years has been self-poisoning a preferable term to Ulcide, for the subconscious motive of those who poison themselve i not usunlly to kill them elve but rather to create a crisis leading to an escape from som e intolerable per onal problem, though they often suceed III killing themselve in the proce s.

Self-poisoning has become epidemic

recently in this country. Last year there were 3,974 deaths from it over half the number of deaths from road accidents. Self-poisoning now constitutes the second most common cause for emergency admission to our general hospitals and is thus of great importance to ambulance workers. The epidemic corresponds with the increased use of barbiturates tranq uillisers and mild analgesics. Such agents offer a more comfortable means of self destruction than attempts at hanging, drowning, throat cutting or drinking lysoJ. Further, it is easier in some domestic crisis to draw attention to oneself by taking a handful of pills from the family medicine cupboard than to develop an attack of the vapours or hysterics which were more common reactions to intolerable situations in days gone by.

The easy accessibility and ready availaoility of medicines is of great importance in the accidental poisoning of little children and in the impulsive acts of self-poisoning to which reference has been made. A careful and now famous investlgation of 500 households in the Torth of England industrial town of Hartlepool disclosed in their medicine cupboards 43,000 tablets or capsules, 16,000 of which had been prescribed for their action on the central nervous system. Based on the number of households and the 100,000 population of Hartlepool it was calculated that a p proximately 2,500,000 tablets or capsules might be available in the medicine cupboards of the whole town, and that if H arrlepool is at aU typical of Britain (and there is no reason to believe it is a very unusual place) this would represent 1,:250,000,000 of such items in the UK at a co t to the ational Health Service of approximately £6,500,000. Psychotrophic medicines those

Use and Abuse of Drugs

( contd. )

acting on the mind are extremely valuable when properly used. As ha been aid, they have altered the whole atmosphere and length of sta) w our mental hospitals, they have aved innumerable people from anguish of mind and suicide and have brought the merciful dispensation of sleep to thou and of people in need of it. :\evertheles they are being overu ed nowadays, being 0 often prescribed J placebo ju t amedicines to please and to ati fy. There is a place for placebo pre cribing when uspectanr treatment i indicated or JU to give hope in certain condition. Probably the better the doctor the fewer placebo he prescribes because a good doctor is a placebo in him elf. deploywg his personalH! a an aid to treatment. When placebos are prescribed they hould be cheap, innocuous and pharmacologically relati\ ely inactiw. The old tonics we u ed to gl\e fulfilled these criteria. The modern hypnotic and tranquillisers do not.

Last year there were over 20 million prescriptions written in this country for hypnotics. representing sufficient tablets and capsules on a rough calculation, and provided they were all wallowed. to render e er! tenth sleep in the CK to be hypnotic-Induced. There were 5. -00.000 prescriptions for major tranquilli ers. let alone the minor ones. ufficient. again on a very rough calculation. to give a month's treatment with a major phenothiazine tranquilliser to tenth person in the country. There \\ere 4, -00,000 prescriptions for an ti - d e pressants. par:Jdoxically often combined \vith depres ant which seems rather a contradiction in term a little like the Frenchman's idea of Scotch whisky toddy: 'You put in \\ hisky to make it strong and water to make it 'i eak, and sugar to make it sweet. and lemon to make it sour. and you ay 'a vous' and drink It off yourself."

Lastly. up to a fev,' years ago 4.000.000 prescriptions were wfltten each year for amphetamine (Benzidrenes, t hough fortunately these are les frequently prescribed now. Thus. the e meretnclous medicines of minimal therapeutic value, were available to be pilfered for the black market in process of productIOn. during transit. from pharmacist's shops or from iat tired mum \\ ho had become dependent on them. It seems sometimes as if we have become disgu ted WIth our state oi consciousness and do not mind very much ho\\ it is changed. either depre ed or stimulated, 3S long as it is changed: '1 don't know." s:.Ild the young \\ oman in the Yorker magazine, 'whether to take a Benzldrene and go to the party or a S econal and go to bed.'

There are three pes of medICInes : those that have to be pre:.cribed. those 14

that must be p'lrch:.l ed from ph.lrmaClhops (though not neee :uily with J prescription) und tho e on a general -ale Ii t that can be bought from multiple store or from lot maeh!l1e It i righ and proper th3[ Imple fJmily remedle' to :J uage tranSlen J.che and laIn to oothe in ect bItes or to rehe\'e contipation hould be freely available 0 the general public. and it would be l'1tolerable to put this further burden of pre cribing on an already o\'eT\\orKed medical 'Jrofe-sion tlme an individual required In a pmn or a In3tive. Yet such Imple and apparently innocuou medi'mes ..Ire often abu ed by the public \\ ith enou re ul t The chiei ones in thl re pect are the mi'd of which aspirin i the mo-t o mmon representati\·e -\ -pirin is a mo \"aluable medicine with a remarkJble range of action: it i analge-ic: It anti-Inflammatory: It I hypoprothrombinaemic: it lower the blood ugJr: it i a mild local andestheti" when put into the ca\'ity of :l tooth or onto a ron-il bed: it \\;} -e ou up when ! ou are sleepy and l.tll ou ro leep when you are WJKe'ul. There :lre. however. no lher:Jpeutic roses without their thorn and a -pi rin no e xceprion to this rule: it c:Jn callse urticaria. a-thma. dy pep-Ia and occult or acute ga tro-lTItestinal bleeding. Suc!l reaction. ho\\ ever. are not nece sarily due to ][. abu e as they occur In ensitl\'e persons a.the result of quite small do e : but enous and sometimes fatal kidney di a the result of mild a'1..tlgeslc only oc ur after their abu-e for many years. This form of gros a buse is most ommon in Czechoslo\'akiJ, \\ Hzerland 3nd Au tralla \\ here It I not unu ual for people to develop a pe of addiction to such medicines. especiall! thoe engJged in meticulous type of work uch as S\\ ISS \\atchmakers. 1 was In Z urich orne year ago and on bemg given a cup of coffee In a restaurant \vas a ked. 'wlth or \\ Ithoui: if you aid 'with' you got two little capsules of aspinn. phenacetin and caffeine in the -aucer of your coffee 'up. o a customed were people to consumIng such thmgs. This abu-e g e' on in country too. though to a Ie er e.\:tenL and we are seeing more and more Idney disease as the resul of it. PhenacetIn eem to be the chIef culprit in [hire pect though It i mu 'h les prone to C.luse ad\erse effect on the alimentary tract than aspirin. Throughout the Jge much III health has been attTlbuted to foci of "CpT. [n the old dJYs \\ heT} I fir t \\ ent into practice there \\ as a great deal of unnece sary urger! underta.'en, especially among the privileged clases, to remoVe teeth. \..hronIc :Jppend'ce, gall bladders and :.0 ivrth \\ ith :.t \le\\ Of eliminating foci If :.epsis -upposed to be -::auslng chronic dlsea -e. e pecially rheumati m: and the maJO[lty or "hlldren

lo"t their ton II reaching adult life. We ha\e modIfied our about thi no\\. nother focus of sepsis wa - then :uppo-ed to be the 'olon which wa regarded a a 'ort eptIc tank I'1serted into the body by he 1'1 the 11th and 1 th .:entune medi"al largely conS:s"ed of bleedIng-. \\eaung. bhstenng :Jnd dra ·tic purgatIon. In m1 home town of EdInburgh. Dr. Gregory , tamou or perhJP notonou for the row d e r \\ h i c h be a r hI n a me .:om;--i:J,,'ently pre- ribed _0 gram - of \:alomel :1 fear-orne dose 0 th unforrunJte liege

In the 19:0 such elImInatlw t rea tment enJ01 ed :1 Tier 'e Indl n summer. In hI b ter year that great and intluentiJI Jrgeon Arbu hnot L:.Ine had not [Ll to b -t but h:td \\ andered "I int) more recondite fields where he redl' overed the colon a trle ntgger in the \\oodpile 01 health. nd intelin:1l toxaemia was blamed. u.-ually quite erroneou·ly. fer much ill parucuIJrl) various ....,.- rheuma -\[' of ex es-iw p rgallon nd olonic :a\..t g followed wh'-.:h ha- -onunatdy disappeared. F ortunately. too. we have largel 1 -w;"lped do mg our children on Saturday night. \\ hdher th ': were con tIpated or not. w ith Gregory'mix ure. -caD rup OJ- "i g _. In the mista.-en belie' that II \\'a- bene:1 ial to gl\e them 'J g ud "I ar '-.." r do \\e give teething p \\ders ontamm g mer.: i) \\ hi h resu ted In pin' - di·ea-e. ·evenhele". these old -f:l hioned ideas take a long time to die and there 1- -ttll a good deal of ;} ble of la xa in? b) he public. gi ,'lg ri e to Irrit:.tble olon. mu ou- 'o\Jt,· and 0 forth. \\"eh ould remember hat 'on-tip:lt1on L much Ie - dele ten us health than over enth si:rtic eff [(5 to treat it Dunng he \J -t 10 year we ha\'e become more aware of the dangeL which mJY arise from the interaction' between medlline- and from gl\mg a number of different one- at the arne time We hJ\-e re;}li-ed that one medIcine glwn al ng with another may profoundly alfect e:J\..h other's action, eIther mhlbHIng or arre tlng their effectivenes". It orten nece ar! In the course of an illne' to treat it wHh more than one medicine but their interactIon with a.:h other are often i'1suiiiclently appreciated by heir blithe: prescnber-. It is not uncommon [0 encounter be\\ tldered old people ta:":ing three. four or even fIve potent blets in the course 0 the day and gettIng them all muddled up in the process '\ or doe' onl) h ppen in practIce: It I-td'1penS JU t a much in ho pital ome years ago. for e\.ample, there was an Inve·tigation into the t:1en new penIcillin ampi lllin 111 the Johns H op"Ins HospitJl at B3Itim or'. \\ here the tandard therdpeu ic 1.:ertJinly not blow a\'er;.,g' Ii wa founa

a a Ide-elfect ot that that the J\'crage number of other that the pJtients in the senes hJd been given \\hile In-patient (Including b:-.ull\eS und hypnoti ) was 14. The lert that any had had \va -ix other medicI'1es be 'ide the ampicillIn. and one patient had hJd 3

With the Incre:.lsIng p of modern therapeutic Jgent an e\ er i'1crea i'1g [j-k Jttends their imultaneoll lie and we hould be cautiou of giVIng more han ne at 3. time unless we know what we are about.

Lastly. the bill for vitamin pre pna t io n pre cribed under the .\ational Health Sen'ice in this country come to over £-l million a yeJr \\ hich no JLCount of the con-Iderable urn .,pent b! the public in purchasmg for rhem-eh e O\'er the counter vitamIn upplemenr-. \ 'i,amin supplementation i:.. of course. often mo-t \uluable for lactating and pregnanr \\ omen. ior little bable and gro\\ ing children and for orne old peopk, e pecially when living alone. ·ewrthe!ess. t'le \\ holesale consumptIon ot \ Itaml'l L ncentrate- In thl" prosperou Welt"are by \\ ell-nouri hed people ha redLhed absurd proportlons It i ior:unate thJt the water \ ItJmins, such a,- Band C. are and quiLkly elimInated by the hUman body. but imagin tion boggle :H the \':1 t quantities

of them bemg dally secreted in the human urine throughout the c )unrry. The fat soluble 'itamin and D .Ire not got rid of -0 asily and poiSOnIng by an excess. particularly of vItamIn D. docs OCLJ _O:lJ.lly o.:cur In people who think that If a lillie docs them g ood a great deal will do more good. On the whole. however. [he harm done by the unnecc ·:.ary consumption of \"ltamIn concentrates is limited to the e.: )nom\- of the State or the pocket of the IndlviduJL DOllbtles there i. no medicine whi ch IS not ometime prescribed un\\1 ely by members of my profe SlOn or taken ine"pon-ibly by orne member of the public. think. however. haw mentioned tho e medICIne most commonly abu ed by the public which they can purcha. e for Ihemselve-.

Que tion time

Q : Ha al ohol not got a therapeutic value in coronar) heart di 'ease

A : Thi an interestmg questl n but I ttnd it h:Jrd to answer It. When I said alcohol has no therapeutic \allle. that generalisation should po ibly have been qualified. 1 k.now of no 'ientific In\e::tlgJtl n which prove::. that drinker of Jlcohol are less liable to coronary disease than ab -tainers. Alcohol diIJte cutaneou"

The JURIbulance

LfO' Tr t. ;J ne\\ h:HiIY. recenll} dl pI yed II Jumbul n e. :1 .lO(I mbul3ncc-L 03ch. Ihe m..lin function of \\hich 10 [[3n port and iLk to LourJe,. BUI Ii i hop d lO :lcquire furth r vehlde for lran punmg Ihe handic3pped to place- of re,1 :lOd nJO) men!, 3 \\ ell p!lgnmage,. irrepeclI\"' 01 ge. circum lance, or reli!!ion.

TIli\ 12 meHe \\h1Ch ,'rUI :II 60 mph. CJn l:.Ike 200 ('ubi fed of IUgg3gt> and be

arr:.IngeJ for 24 fully rechnm!! \e3h. lO 10 eah nd lObed. \\ ilh other- ,'ombinJtion,. Tht> oa 'h ha au u'pt>n IOn. :m-condilionin!!. toilet. ,in r. cooh.in!! l·ont'-li·ler-. Ir:nell ng hOI'I, ox)gen r;}dlO and L'1.l ,ctte T\'.

The Jumbulan.:c. omplete \\ ilh dmer,. 1 J.\.uIJble for hire at re;} onablt> .:l':uge::. (3llhough mo,t \\ 'ekend ll'i, ,ummcr JIC booked) trom. Hon. t>". The .:ro ero\\ n Hou,;;.> 'Iorde']. Surrey.

blood ve els but it IS doubtful if it has this effect on nsceral ones lIke the coronaries. It is better to u c nitroglycerine. Alcohol. too, increases the concentration in the blood of cholcstrol and triglicarides and thiS mIght increa I.' the tendency to ocardial infarction

Q: \s a night cap IS a glass of whisky g ood"

A: not her good point WhICh it is difficult to an wer dogmatically. belie\-e, and perhap- with justice, that .:l g oo d dram at night a far better sedati\'e for old people than a hypnotic. 1 t sound rather grandmotherly to sugge that Inculcating this nightly habit. espeCIally to younger people. may encour:tge alcoholIc addiction. Personally I find th:Jt though a great deal of alcohol certaInly club me into a 10\\ murtering delirium Whl h passes for -Ieep \\ ith a hangover next morning), yet a moderate amount keeps me awake but people vary in their reaction to drugs.

Q: Would amphetamines be of some value to keep people like doctors awake \\ hen they haw to drive motor cars a[ mght

Use and Abuse of Drugs (contd.)

A: Yes, they certainly would but, 3gain, as they are drugs of dep ndence the exercise of this practice may be undesirable. Black coffee is better, if less convenient than a pill. There are, of course, a few definite indications for the prescription of amphetamine: they are specifics for the very rare disord er of narcolepsy; I am told that a few psychiatric ca es of hyperkinetic chi ldren benefit rather paradoxically from their use ; and they are helpful for some unfortunate epileptic who for their contro l require very large doses of hypnotic anti-convulsants and in consequence are drowsy all day.

Q : H ow about nocturnal eneuresis?

A: 1 am not a paediatrician but my paediatri c colleagues at home do not recommend them for this purpose.

Q : During the war amphetamine were sometimes disguised under the name of 'Special Emergency Rations' to keep men awake and to stimulate them. Were they of value?

A : Ye s, I think they had their value for commandos to give them a bit of pep, to take away their appetite if they hadn't enough to eat and to keep them awake. They were occasionally justified for such purposes during the war but not now.

VISUAL AIDS

The following are available from CAMERA TALKS , 31 North Row , London WI.

SA FETY IN INDUSTRY: 206 /1 an d 2 52 slides and 2 cassetted tapes: £15 00

Amphetamines are mostly prescribed now fo r their dfect in reducing appetite in the treatment o f obesity. Thi effect , however, wear off in the cours' of ;) month wherea s the treatment of obesity has to last fo r far longer than that and the re is Lhe grave rish. of making patients psycho l ogiC<111y dependent on the drug in the process. Fat on.ly co me off a plate and not out of the air Drugs should pl:Jy an in s ignifi ca nt part in the treatment of obesity whi c h s hould be along the hard and s tony path of strict dietetic restricti u n.

Q : Did n o t the o ld-fash ione d b ottle of medicine exe rt a very beneficial psychological dfect without d o ing any harm ')

A: I think I dealt with the possible benefits of placebo treatment for which the innocuous, f relatively ineffe ' tive , o ld-fa shioned bottle of medi ci ne should be used rather than a potent drug. In a wa) of courc, it is ca rrying out a fraud on patients an d 1 can't help feeling that as a profession we hould attempt t o educate the public more than we do in ra tional therapeutic rather than t o pander to its pr imiti ve de ir es, even th o ugh the desire to take med ic ine is the chief thing whi ch dif feren tiate s man from the lower animals.

Q : Don't you think the immediate analgesic effect of alcohol IS in t; ': treatm ent of many cases'.'

A: ,\g lin, perhaps my tl' :t, illco hol has n o therapeuti c value requires qualifi catio n , for a good d ose of it depre sses the pain c entre in the brain just as it d ocs the whole or th e ce ntral n ervo u ystem.

Large quantities, t hough re li ev ing pain, increase the shod. which ma y be present by sti ll further owe ring th e blood pressLire 1( sho uld also b e remembered that if alcohol is given as ,I first-aid treatm ent it may potentiate the efrect or ot her drugs which h ave o be glvl'n <; lIb seq llentl y s uch il'> anaesthetics, op iat es hypnotics. F or obvioLis reasons we "hou ld nol reauily res II to alcoho l [0 1 chronic or reclirring pain.

Q: H ow about giving alcohol to revive a per<;on I) in g in the <;now say, a acci dent '?

A: 11 IS a bad thing to J..eep out the co ld as it ca use s uilation of the skin vesse ls and so facililall.'s further oss of heat from the body : but it is e\cellent in reViving someone after he has been brought into warm surroundings out of the co ld

Q Is alcohol not exce ll ent for the treatment of the night crumps in the legs of ('lucri) people?

A: sma ll dose of quinine at night is much bette!. it shou ld have this specif C crrect is not ver) clear to me but It is much more drective than alcoho l.

The St Jolin Ambulance i\fulli j\[edia ; tppraisal Panel, H'llIeI, mcets /orlJliKllfly al fJQ alld comprises doctors, IIl1rSe S, first-aiders alld JlSlwl aid cX{Je rI S, IY olle o/llle ojjicialll ' apPollited panels 0/ th e British M edical Associalioll, liS rel'iews heing pllblished ill tIle' BIIA In jo rmation' III 1972 Ih e Gilide 10 Films alld First / tid was pllblished (avai labl e jwm thc Storcs, 35p pillS postage). III l77id 1974 it is hoped to puhlish IVlt11 the k illd aSSIStallce of fhe British Life Assurance Trust a co mprehcllSiJ' e multi·media gllide 10 lI1aterial Oil /irst ald. nursing alld allied topics.

The purpose of this presentation is to fost e r safe working practices in industry.

The panel considered this a very useful program me dealing fairly comprehensive ly with eye injuries and skin infections lik e ly to be met in industry. Prev ention and treatment s arc s uccin e tly portrayed. The programme is a little lengthy and the voice of the commentator a shade monotonous.

Audience : Mainly for industrial induction courses, Occupational Health Training and Apprentice Training Centres

THE ROLE OF OXYGEN IN THE BODY: 232 23 slides, lecture notes : £4.50

This is a useful set of slides that illu s trate s re s piration; the production of energy by sim ilar processes arc quoted as examples to emphasise the importance of oxygen

FOOD FREE FROM GERMS: 259 37 slides 1 cassetted tape : £7 50

This presentation is directed at the catering trade and kitchen workers in particular, although the tOPIC of hygiene has univ ersa l application.

The panel considered this an adequate pre entation that 16

sufler s from its parentage: it is produced by a Divi sion of the Jeyes Group (pre sumab ly German) and this is biased on the s ide of 'powerful d e t e rgent s': ilmongst Significan omiSSion mlght be menti o ned re frigeratio n and the lise of Impervious Nonetheless, the s lick s are goocl, the co mmentar y first cia · and the programme has value for hygienlc food-handling courses.

Audience: Catering trade , rood-handlers and cou ld be used for cadets for general inter est.

LIFTING IN HOSPITAL

Slides and Tape/slide £4.50 each part

Camera Talk s production in co-operation with the Nightingale Training School and the School of Phy siotherapy, St. Thomas' Hospital.

Part 1: Shoulder lift , adaptation for right thora c tomy . Rai slng Bed with Elector, Putting Bed o nto Block s. 21 s lides

Part 2: Transfer of the un co nsc io us patient, I [emaplegic pati e nt s. Lifting a right hemapl egic patient. 19 s lides.

It is axiomatic that the b es t audi o visual aid m e dium for nursing procedures involving mov e m e nt is a 16mm film o r 8mm

Io?p within the limitations of s tatic tra nspa ren c ies thlS programme IS acceptable.

The panel c?nsidered it essentia l that the programme be prefaced by an ll1structor giving an exp anation of lifts involved and that the fo ll owed by practica l work. Th e panel that one s lid e s howl11g a nurse lifting a bed unaided is Incorrect p.roce dure and that so me other s lide s were not clear demon s tratlon procedures; however , all-in-all , even though uniform Indi ca ted this strip is dated it still has teaching value.

A lIdience : Sl. j o hn members und e rtaking nursing or home nursll1g courses, nurs ing cadets, etc.

FI

RST AID FOR ROAD USERS

2 Tapes, 103 s l des (Parts 1,2,3, inclusive): £19.50 com ple te 8mm loop s are a so avai a bl e Thi s.e rie s is designed t o teach elementary priorities of first a id ln a lngle sess ion I t illu st rat es resuscitation , re covery position bleedIng, treatm ent of fructures an d includes practical points of car crash procedure.

It was n o t the opinion that the basic priorities of fi rst aid and practlcal pOInts of ca r crash procedure ca n be taught in I ho.ur. the premIse of this production. Furthermore the pnontles as sl:o wn in thlS programme are incorrect, the lnsi tence on ot personnel unwis e, and the lack of thorough examillation 01 patlent noticeable ; some out-of-dale treatments arc also apparent.

The presentation con t ains too much t ec hni ca l informati on WhlCh would be over the head s of the intended audience.

o t r eco mm ended in it s enti rety for first aid training dIthoug!l some Ilde s coulu be elected for instructor's use.

AudIence: one until reVIsion effected.

FIRST AID FOR FRACTURES

3 T a pe s for complete se ri es: £36.00 Complete 8mm loops are a lso avai lab le

Part 1 Gen e ral Intr oduction

Part 2 The MandIble and kull

Part 3 Th e Spine

Part 4 The Ribs , Clavicle Upper Arm

Part 5 The Forearm and Hand

Part 6 The pelvis and low e r 11mb

Fram es

Frames

Frame s

REVI EW CROSSWORD No 7

(73)

Compiled by W A. Potter

ACROSS:

1 Tough, tissue co vering articular surfaces of bone. (9). 6. GIrl wlt.h nng,ror ca t c hing cattle. (5). 9. Plant indicating the state of the (5). 10. Condition due to excessive exposure to solar radIatIOn. (9). 11. Lon a protruding tooth (4) 12 A se k b, nous flS to life and limb. (5). 13 A little sp irit as in health resorts. (4). 16 Draught used medi c inally. (7). 18. 12 across for vessels on the orth Atlantic before the advent of radar. (7). 21. Wax produc e r. (3): 22 A good woman from all points of view. (3). 23. R e uters prOVl?e tubular parts of urinary system. (7). 24. Meaning to ?e ln a sa tlsfied state of mind. (7). '25 Take winding lane for an llnpctuou dash. (4) 27. Arm o r leg and nothing more in abode of lost. souls. (5) 29. Short , s harp breath as taken in by general practlcloner. (4). 33. Dressing soaking up exudate from wounds. (9) 34. Muscl e supplied by the corona ry arteries. (5). 35. Tropi ca l fever of a fop. (5). 36 May be welcomed by short pa tlen ts req uiring transport ') (9)

DOWN :

This cries is designed as an instructor aid; the commentary is a supplement to the instructor's comments and audience participation is recommended.

Each of the 6 topi cs may be u se d ind epe ndently. panel considered that thi erie sho uld be withdrawn for reVI SIon The teaching portrayed in thi se ries is out-of-date: there a lack of examination, suppo rt and maintenance of lI1Jured lImbs , and adequate dre ing of wo unds . Nonetheless, selected slides from this serie n o tably -ray photographs of selected fractures well co uld be valuable in of an instructor' pl'rsonal lide library

AudIence : ot recommended

NOISE AND HEARING:

263

Slides or filmstrips, - cassettes or tapes

60 Slides in 2 part series: £15 or £13

This set witilln the series Safety in Indu s try portrays the damaGe nOise ca n ca use. eo

The pan.cl co n idered that this pre entation raill.'d in it purpose; a plethora of techni 'a terms it presents a technlcal subject Without clarity to the uninitiated it is mealllIlgles s and to trained personnel so mewhat pOintle

Audience: 0 interest to Sl. J o hn a uuienee '.

1. Malignant gro.wth placed on the head (5). 2. Ruby and 14 down arc Ingredlents of appliance for aspirating the stomach. 3. Germ of progres 4. Suppurative lesions requiring In C1S lon and dramag e. (9). 5. LIstlessness of French origin. (5).6. De cea ed after the usual time. (4). 7. Flex the spine. (5) More than a se ns e suggests a of vigilance. (9). 14. Canonised fish for manufactur e of surgical instrument. (5) 15. Laxative from caS'la plant. (5). 16. She wa s evidently in c lined to suffer from bursitis. (9). 17. Complete group to reduce and ImmobLI! e a fracture (3). 18. Provide good growth prospects for premature baby and bacteria. (9). 19 With the exception of upturn ed tub. (3). 20. lIergi' reuction to rectal admini tration of nUld. (5.4). A Royal So c iety on fire-rai ing. (5). _8 J.ntestll1al obstructIOn. (5). 30. Car park with wrong rate for !athet:- (5). 31. r-.latter of brain. (4). 32. Pellet for intramuscular InJcctlon (4) (5'"O/lItlOl1 to tillS crosslVord all p. 24)

SOLUTION TO CROSSWORD No.6 (73)

ACROSS :

I. ccommodation: 9. Triceps 10. B.is.muth : 13. Ero: 14. He.llx: 1.\ Aura ; 18. Toddler: 19 E tra.ct; 20. My.co. i : 23. C'.hole.r<1 , _5. ato 26. Viral: _7. O.pal; 30. a .s cent; 32 In cisor' 33. Ethyl chloride.

DOWN:

- Cricoid; .3. Open; 4 r-.la se ur: 5. Debride: 6. Te t; 7. ut ; . II. U:,ula ; 12. failure: 16. Flu h : 17 Stool: _1. CULl ; 22. clatlc; 23. ramal; 24. Expo ed: '2 Deny 29. Scar :3 1 te o 17

TWO-PERSON TECHNIQUE

from D. Little , Ambulance Memb e r I have been int r iqued for some time since the re-introd u ctio n of the H o ger- ei sen method of resuscitation why the following two-person technique has not been included in the manual'.' TIl(' technique req u ires the first operator to po ition hims e lf and carry out the movements as detailed in the manual, while the second operator (possibly a bystander or another fir t-aider)

hi m se f as shown, providing extension of the head by support1l1g the patient's forehead with his fingertips slight ly under the eyebrows. T h is ensures that there is a clear airway, which is not the case when the head is turned to one side and re ting on th e han d s The second operator does not obstruct the movements of the fi rst operator as hi arm kept straight and above the centre li n e of the patient's body An added advantage i that when one operator becomes tired they can change positions and the r efore continue re usc it ation for a longer period of time.

READERS VIEWS

Readers' views and OpiniOnS, which should be sent to the Editor, al t hough published are not endorsed by the Editor or h e Order o f St. John and its Foundations. Al t hough readers may sign pllblished letters With a pen name, writers must supply their name and address to the editor.

I first saw this method applied in Australia in 1968/69 by members of life saving c l ubs. [ would be interested to know if this technique was considered when compiling the new manual and if so what were the reasons for its rejection?

Hatfield, Hats. D. Little

Pr o f ess or H. C St e w a rt Ch ief M e di ca O ff ce r , r ep ies:

T he J oint Committee of the Voluntary Services did not co n s id er he H o lger- ielsen two-person technique at the time the 3 r d edition of the J oint Manual was prepared possibly because he technique was not known to them. The reason for inclusion of the H olger- ielsen method was that in the 2nd edition of the manual t here was no prone position resuscitation, only supIne, a n d manifestly this lack needed revision.

F irst aid is a skill that is taught so that it may be carried out by a single individua l in appropriate circumstances (witll the exception of stretcher-carrying and such dril l s). Although the t w o-person technique is possibly more efficient within a team-work si uation, the authors a l ways bore In mll1d the necessi t y of reducing fi rst ai d to the leve l of what IS a possibility fo r one pe rson.

The R evision Committee is grateful to A/M D. Lillie and will in fact conside r the two-person technique when the next edition of the J oint Manual is under review.

edge of the this may re-start the heart beating.

J ust how much pressure the tl'fm 'strike smartly' conveys varies from a full-blooded karate chop to a soft tap, wi th greater or esser amount of damage to

The arguments revolVIng around the degree of pressure to be used are legion among in tructors within my own orgam ation.

Dr. J. Wi l d of the Permanente Clinic, Portland, USA, ca lls the technique 'Chest Thumping ', again not a very concise expression.

I have been told by a member of the medical profession that patients fitted with pace-makers arc taught 'chest tapping' a'> a necessary expedient when the pace-maker becomes faulty So from chest LIpping to karate chops. Just what does the poor lay instructor teach? Another interesting snippet from Dr. Wild's paper state that thi sy tem depolarised thl' heart (in the case of heart block) and was thercforej()llo\VeJ by a normal contrac tI on. Since the contrC:lction occurred after the d epo lansatlOn It possible to feel the puhc follOWing the blow, and the presence of a pulse was not dIsguised by the disturbance of the body produced by the actual physical treatment a in the case of external cardiae compression.

This LO me means that there is a between the thump and the presence of a pul se.

Surely this vital Information should be in the manual') I maintain that resuscitation is the most Important feature of first aid learning, and In my experience the subject least under stood.

Surely someone can give the nece ssa ry guidance and produc e it both in writing and in visual form such a that excellent film The P ulse of Life

Shrewsbury j olin R. Dal'ls

other authorities of overriding eminence in this field. Mr. Davis should avoid, we think, confusing first aid procedures with the maintenance treatment of patients fitted with pace-makers. The lay instructor will incur no difficulty if he adheres to the teaching laid down

RECOGNITION

fr o m M V. Morin g, Sgt, Di visiona l Secretary

The main point of my letter concerning recognition of full-time Ambulance Aiders (November Review) seems to have been misconstru ed.

I was suggesting a means of instant recognition of fully qualified Ambulance Aiders by senior officers (who may be unfamiliar with the personal background of members in their charge) on large public duties or major incidents

I agree wholeheartedly with Mr. R. Ingram (June Review) that what you do is all that matters so far as the patient is concerned. Qualifications are only as good as the holder. Surely though, on a point of administration and delegation, easy means of identification are essential? That is why doctors wear red piping, officers rank markings , and SRNs red bars and grey epaulets. [ do not consider this as 'going around dressed as a Christmas tree'. There are many superfluous Brigade badges which could be eliminated and r applaud Mr. Ingram for disgarding his 'State' badge as a possible environmental hazard. He still has means of recognition.

As to the ability to recognise the 'professionals' in our midst this clearly lies with the officers making the appointments. Ever; officer and NCO (other than surgeons and nursing officers) is interviewed and/or examined prior to appointment. This examination includes the recognition of insignia.

For Brigade members to work well for the Service of Mankind team spirit is needed - and teams need leaders. The best qualified leaders are those who have adequate knowledge about the individual capabilities of each member of the team and delegate responsibility accordingly.

Sour/7end M. V. M o ring

CURIOUSER AND fro m M. W. H arris, A r ea Supf.

I would never have believed that my use of the expres ion 'loss of dignity' could have caused ueh a furore among the readers of the Review Unfortunately, most of your corre pondents on the matter have quoted me out of context. My late critic, lr. Rex Ingram, has done it again. lIe also makes the mistake of criticiSing without knowing the full facts. He goes to some length to justify his criticism of myself and another contributor (a Mr. Moring) by telling us all about himself and what he does. Perhaps I should do the same!

For Mr. Ingram to remind me of the Brigade motto is, J think, fatuous in view of my 41 years' service.

Finally, might I bring this correspondence to a close by referring to my original suggestion which was, simply, that in any year in which a lay instructor gave a full adult course of lectures he (or she) should be excused the FA re-exam for that year. It seemed reasonable and logical to me, although I did not stand to benefit from it myself.

Hove, Sussex

FIRE BLANKETS

from Norman Wa llis, Man. Dir. T utor Safe t y

M. A. Harris

RESUSCITATION

from John R. D a vi s I was interested in the article on resuscitation in the Review (J une). but as a lay instructor I would be considerably more inte r es t ed in knowing the correct interpretation of resuscitation as exp ressed in the 3rd edition of the manu<ll.

I refer specifically to cardiac resuscitation, which was generally we ll u n derstood until the 3rd edition brought in an added facet wh i ch is not named b u t is what I prcrer to call 'heart stimulation'.

T h e w h o e paragraph dea l ing with this facet is so vague as to be a lm os incomp r ehensib e.

The sen t ence most severely under criticism is : Strike his chest smar tl y to the left of the lower part of the breastbone with the 18

P rofessor

H C. St ewar t C h ie f M e di ca Officer, rep l ies:

We were very interest e d to see Mr. J R D<lvls 's letter concerning resuscitJtlon, since we share hi s view that thIS IS one of the major 11fe-savlng procedures taught in the 3rd edition of the J oint First Aid Manual.

Little difficulty appear" to have been encountered by those either teaching or being taught , from this volume, since some 260000 certificates have been Si nce the edilion first pubiished In J anuary 1972 We were privileged In the drafting stage of this to huve the henefit of Dr. 1. Wild 's published :",ork, and also the pleasure of a personal appearance. The wording In the present manual is in accordance With hi s advice, and With

Mr. Ingram states that he is a Grade II Staff Offi cer, and that he is exempt from taking J re-examination in first aid. low isn't that strange I, too, hold that rank and am also exempt from the need to take are-exam. Mr. Ingram also states that he teaches all day long, although he does not ay in what connection, and that he feels that he could ca ll himself 'a professional (as opposed to a lay) instructor '. Curiouser and curio user! I also te ac h all day long - in a large grammar school where, as a biology specialist, I am primarily concerned with getting our senior pupils through their A levels, thus opening the way for many of them to become doctors, dentist, etc.

Mr. Ingram further informs us that he instruct regularly at St. J ohn clas es. My own record over the past five years has been to give the complete set of lectures , and take the practical work too, a tan average of three ad ult first aid course each year.

Mr. Ingram upports 'his case' by telling us a bou hi publi c duty. It appears that he joined the boy (A / Ms) at a grass track meeting and finished up rescuing a female driver from a Mini, and getting his uniform dirty in the process On numerous occasion l ast season ( joined our local divisions on the Brighton & Hove A l bion football ground, but I soiled my uniform when on my knees giving the kiss-of-life to a heart case.

Preparation of a colour code to differentiate between various types of fire extinguisher is now being undertaken by the British Standards Institution.

Another problem on the identification of fire safety equipment does not yet seem to have been given attention. That is the question of fire blanket sizes.

Lifesaving models are sold in several different sizes, with 6ft square, 6ft by 4ft, and 4ft square as familiar choices. All of those can be justified by one argument or another, or by the nature of the personal fire risk encountered in a particular place.

But what about the quite s mall models, intended to extinguish pan fires in kitches, laboratories, and so on? They go down to below 3ft by 3ft but are all labelled 'fire blanket ', like the larger sizes. J cannot see that they are big enough to wrap around fire victims set alight from head to toe in the explosion of an aerosol or the like.

Have we not reached a point where a band of sizes between say, 4ft square and 6ft square should be laid down for lIfesaving sizes with the familiar fire blanket label? Smaller sizes could then be given their own des cription on the label although in a generic sense they could still Come under the fire blanket heading for trade purposes.

I uggest 'fire smothering cloth' as an accurate term for the small types, to ensure that a rescuer would not waste vital seconds taking hold of a 'fire blanket' smaller than he had envisaged.

D orse t Norman Wallis

FIRST -AlDER'S ROLE

from J ames M. Stewart, S ergea nt

How many times have we been on duty when members of the public have come to seek advice for such symptoms as headache, pains in the abdomen or back, etc? When told they should seek medical advice they usually reply: 'You should know what it is. You're a first-aider, aren't you?'

Having been an S] A member for nearly 35 years and over 20 year in the fUll-time ambulance service, I have lost count of the times that I've been asked that question.

We in St. John must never be tempted to use these occasions to try to impress people with our superior knowledge. It is mo t important to suggest to the person the advisability of obtaining medical advice or opinion. There are few martifestations that not infrequently betray the onset of some dangerous disease which, at that early stage, is often amenable to skilled treatment. At the same time, these manifestations for the most part closely resemble others of less or even of no sinister significance. That is why it is necessary to obtain the opinion of a trained and experienced man, the doctor.

Amateur diagnosis in the e orts of cases is nearly always wrong, and therefore nearly always dangerous. P rofessional diagnosis may be wrong, but it i generally right.

We in St. John must remember 'a first-aider mu t not take the place of a doctor'.

Feltham 1. Stewart

NEWS from SCOTLAND

The St. John Festival ON JU E 23 the Annual Commemoration S ervice and In vestiture of the Pri o ry of Scotland was held in East Kilbride, the new town south of Gla sgo w which has in a real way a d opte d the Order of St J o hn Ind ee d a list of local members would be virtu;:llly indistinguish a ble from one of the burgh establishment - it would include both the Provost and the G enera l Manage r. East Kilbride has taken the Ord e r to its heart - almost as a com munity project - and it ha s d o ne so with tremendous warmth and enthusiasm. It has become th e maj o r co ntribut o r to the new and exciting Glen shee scheme, a bout which more in a future NeHls from Sc otland.

The day could not have been better organised or mor e su ccessful. After the commemoration service in the Old Parish Chur ch - the nucl eus of East Kil bride is an old village - at whi c h a st irring and thought-provoking sermon wa s preached by The Rev. R. G. L a wri e, Chapter was entertained to a m agnificent reception and luncheon by the Provo st, magistrates and councillors of the Burgh - a highlight of this was a witty speech of welcome given by our new co nfr ere , Pr ovost J ames Smith Then came the General Assembly and Inv es titure in the sp en did Ballerup Hall in East Kilbrid e's new civic centre. A feature, wruch must be copie d on future occasions, was a finely organised and beautifully laid out exhibition on the history and present work of the Ord e r, arranged by Mr s Wilson and placed at the entrance to the hall. It att racted mu c h interes t an d mu st surely have h elped to gain us new recruits.

At the General Assembly th e following were invested by the Prior :

As Comm an d er (Brother)

Dr William MacFarlane Gray. Colonel Alexander Walker- addell Ord Kennedy Reid. Thomas Falconer Robson. George Wallace.

As Co mm and er (Sister)

Renee Caroline Fr ances, Mrs. Bu c hanan-Dunlop

20

(Above) Members of the 0 r der arri vi ng at the East Kilbride Old P arish Church for the annual commemoration service.

(Right) The Marquess of Aberdeen and T emair, the Prior of Scot and, invests Mr George Young, general manager of East Kilbride Development Corpor a tion, as Officer Brother Left is Sir Andrew Murray, C hancellor and Registrar of the Priory

As Officer (Brother) David Fyfe Anderson.

Sir William Denham Barnet so n la irn Reid Cowan. Sir Hugh Fraser.

Chief Constable Edward Frizzell. eil Aylmer, Hun ter of H unterston.

Sir J ames Ril ey Holt Hul chison, 81. I an Austen Laird. Colonel Tom Bell Maxwell Lamb. David Watson Law. Al exander Mennie. Pr ovost J ames Smith Alexander Bache Walker. Maj or Ilartl ey Waddington Whyt e George Bell Young.

As Officer (Sister)

Georgina J essie, Mis Graham Bessie Pati ence, J ohnston.

As Serving Brother

Gordon Dun ca n Nic o l Agnew.

R obert Pet er Malcolm Battison. Charles J ohn Burnett. Rob ert Burnetl. Frank Campbell.

Bri a n Fra se r Al exa nder McCask ie. Charles H edor McLean. Ron a ld McMillan.

J ames A ndrew Pip er Milne. William Archibald Gordon Muir.

WALES

The Lord Lieutenant of Fllntshlre, Brig. H S. K Ma nwarlng, re cen tly presented right a service medal to the County CommiS Sione r Dr H J Bradley, an d (left) two Grand Prior badges

OVERSEAS

James Scotl Ridd e ll. Michad Br )':111 <"LIlt'r. Willi am Fori Slal k. William W:J1kL'1

A Serving Sist er

Fl orence \\/ .1 [>..tl 11, \11' \. Crulcksil.Jnk.

Is obel Botll\\L'11. \lr,>. Clark Mary J ohnston, \ l rs. hlrrest.

J en nie StevL'n, \Irs. Gordon. Maralcl !vI is s Grallt.

J ean Steven. \lrs. habelLI WIl son, \ 11'

Iv! rs. 1( 1\ l u rt.t y Mollie Katll ennl', 1 1'-';. Orr Grey, \Irs R obh. Isabel CamphLiI. Mrs. Swallney. Lil i La, I rs. \\ innid. Gerlrude, \1 rs. Wright.

Pre se nt ed as Esquire

Rod cnck A!L-\dl1del Shand Sivewnght ( Person:t1 1 sqUIIT lo CJPI. J Shand Sivl'wngh I)

can no con c Iud e 1 h is hrlef of 1I1L' Fesl lval without not ing one olhl'r 1l1 ;1 lt L'r. Sir the d oye n 01 :t11 Knights of Sl. J ohn, wllo muke s a pr<lctice of altending our Sl. J o lin 1'l'\tlv.l ls ;lnd who i\ 110W 93 ye:.trs o ld , par ti Cipa ted fully in all th L' day 's evenh. Ill S pre'>L'ncl' wa'>, alwuys, in sp irali on l o us all. J K.-S

For the pJst 4 ye.lrs .In .Innua walk of 40km has beL'n org:IIlJsl'd 111 lo funds to provick hl'llL'1 in rllra I Thl' walk stalls ;It 6.30 thoLlsands or Pl'op!L- 1'1'0111 6 t o 70-ye;lr-olds. al1d Ilh'llIdlng mini sters, a m b S S .t d ol's h 11 sin l' m l' nan d 110usewivcs la kl' pdrt So l. J ohn /\mbul;IIlCl' IS L'(lllllllilled on tllis t! ;lY. Tile 1;ltesl w.Ilk, 011 \1.1) Ill, 1l(r;l c IL d some people in '\.llIllhl .llonL', ;Ind we had l)O member s (111 dllt\ 1'1'0111 d;lwn lo dll\k \ bOllt 8,O()0 werL' lreat l' d , most ly for Illl lhll ,'.ISL'5 of cramp, bll. ll'rs, culs llld bnIISl'S, hllt .1 fL'w

or hL'Jl exhall tion were rderred to hospilaL Walk' .lisa lake place on the same da) .It oth l'r town s suc h as and KISUlllll , wllL're Olll services are also in great ciemand Il is hoped lo rdise [50,000 LO [70,000 b) lhis erfort.

NIGERIA

Tlie Rl\l'r. .1.1Ie ll'JJll bagged a tOlal of 187 pOlnh lu \\111 lhi\ \eJr's Inler-Stale Fir s t ,\ ILi ('ompctit Ion' of the igeri il Po li ce Distnd of the St J ohn \ mbu\;Jnl'e BrigJdL' , cnnci uded ut the Po lice Collegt', IkeJa in Aprt L I'hl' team \\as wllh the D S. FOLlnt;lin ChalkngL' Cup I\[rs. Dele ALletor o, wire 01 the Federal ('oml11lSSlOnL'r for Indu slr ies and

Chairman of the St. J o hn Council of 01igeria at the end of the keenly contested competition in which 14 team p;Hlicipated.

West e rn and orth Centra l States came seco nd and third with I :2 and 164 poi n ts respectively, while the Dr. Lo n d a le White' Tr op hy for the best individual performance wen t to Constable John .\ruagbon of the estern Slate Team

In a short peeL' h sho rtly a fte r the competition, the Brigade Commi sioner for all open Divi'ions of the Brigade in igeria, \1r. C. D. \1. Le Clair congratubled the partiCipants on lhei; performance urged them to make the be t LI e of their first aid c:\periences ,It Jl1lim

Sore feet on the long

Nigeria's inter state competitions: the Lonsdale White Trophy for John Aruagbon

News from Divisions/Centres

earne saved a chi ld from choking.

GLOUCS - The new HQ of SJA Stroud, acq uired 111 1970 but now extensively renovated by mcmbers, was opened recently by Earl St. Aldwyn, County Chairman of St. John. The premises include a garage, kitchen, stores and lecture room.

HEREFORDSHI RE - The 4-day annual rally of the Caravan Club of GB, held hen: during \-lay, was covered by the Ledbury Divisions and 200 casualties were treated. This IS the first time the rally has been covered by SJ A and so impressed were the organi ers thn t they sen t a cheque for £ ISO to SJA Ledbury. In 1974 the organisers want SJA cover agalll so if the event is to be held in your area

LONDON - The annual inspection of the London Transport Corps, at which 150 ambulance and nursing officers and other ranks from the 20 Divisions of the Corps were on parade, was held in June. The inspectlllg officer, Lt. Col. R. 11.. Payne, Deputy District CommissIOner, was accompanied by District Staff Officer ( ursing) Miss N. L. 100re.

Kid d erminste r ambulance cadets during a recent visit by County Staff Officer B. Roper (centre)

;\ dClllomtration 01 casualty Illake-up \Va, wl'll apprcciatcd by the many gucsts and rriend, p Il"l'll t.

Thc Ikputy District Clllllllll\Sloncr rcmarked on the largc Ilumber of Ilew Im:mbers un parade ane! Illllcie cOlllparl,on, betl\ eell the national rCl'fUltmcllt Ilglln: and the high Corps figure, wilich ror 197:? was apJl[LJl(lmatcly 6 "-1. Col. Paynl' ,,1'0 mentioned tllC ract that the Corps W:JS entering its 50th }ear anti this, LOllpled willi the L"(jll'ct<Jtllln oj' a nel\< \!labile Unit, wlluld Illake 1974 '>omethlllg \pecial ill the Corp, history.

STAFFS 1973 \\ iii bc thc cIVca'>tie Divi'> on< bolh adult and cadet, bU'>Ie,t yeelr in thclr Imtory.

lhe granting of the Royal Charter to the ;\ n c I e 11 tall d Joyal Illl r 0 ugh 0 I e\\L'a,lIe-under-LYl11e, 111 1173, i, bcing l'l'kbrated 111 many "'<lY,>. The Octo-Lentenary Ll'kbratlons \\ ere hlghli!.!ilted 111 Via\' With a VI\it by the OUl'CIl till' Duke of L:linbllrgh Till'> \1 a, thc rir,t of th rce Royal vI,i[s to the 130rough thl' } car. PfllllL'\\ Iargaret ame In JUlll' ,Ind J ul}, although the J'irst or the Prinl'c\\'s viSit'> was 10 meet ,ome 4,OO() I3ro\\ IlIl'S ;llld Cuidc'> ,It Lamp on the oUhkirh or NeIHa,t1c.

PubliC dutll''> covcrl'd by thc dIVI'>IUIl II1c1ude e:Jch \lcd durillg \Iay, June and July, \1 ith t1Hl'C cvenh In /\ugu,t Jnd Sepll'mber, the members or the two units llf the 13f1gade \\ iii bl' sCl'1l III the streels or l'lI'L.I,tle or 111 the arcna at Che,tertoll. Among the even!'> thai helvc be'l'n ,>el'n or \\111 bc '>Cl'll an: : I rl'ctiom 01 the Horllugh tor the Stdllord,llIre Rcglll1ent, Round the '>Ircet L'\ de rall'. mod, eleLtillns, H..A. I'. and Arm}' tll\pla}. Bank l l olida) MondelY ,umiller ralr, 1\ hidl had an estimated elttentiJIll'l' 01 60,DOO, CathoilL prOll"Slon, and meln} other,>. atur;lIly. the lI'>l1al dutil", speed\\ ,1)" stOl kcar r.ll lng, g,lf(lcn partie,>, 'ponslHcLi \",tlk, and c lrnlvals ,till go Oil, ,Inti thc Dlvl'>lon, arc therc. 13) the cnd of the} ear, the nUl11bl'r of dutil', undl'rtaken \\ ill havl' 1110re Ih 11l doubkd. \\ Ith l'on'>lderablc InL'rl'ase In the l11an hOllr,. The 011 "Ion did hllwcver find tlillC tll rclJx Cit the \Ilnual Dinnl'r dnd Prcsl'nt lllonllf A\larlh.

Newcastle (Staffs) N/M Miss Susan Tllstone receives the Nursmg Trophy from Corps Surgeon Dr. J SculiV. (Ll. AIM George Harrison With Senior FA Trophy Mrs. P E Lane, Cader vice PreSident, and D/Supr Joseph Durham. In background ( Photo Newcastle Times)

Smiles all the way at Glossop and District DiVISion (Derbys) promotions and retl rements. (L to R back) D. TraVIS. new DO Cadets, Valerie Mollan, new D S NurSing; L Barnett, new Pres. A Div; Kathleen Downs. rellrlng D S; Josephine Canon new 0 / 0 NurSing, (front) L Jarman, new DIS Amb. and H. Stevenson, retiring D S Amb.

Revi ew Sa l es, St John Ambulance , 1 Grosvenor Crescent, London, SVJ X 7EF

REVI EW CROSSWORD No.8 (73) Compiled by W. A. Potter

ACROSS:

1. Corruption for tissue transplant. (5). 4. Vector of sleeping sickness. (6.3). 9. The French page with bright ending to scourge of mediaeval Europe. (7). 10. Told what to do without confusion. (7). 11. Orn amental appa rel from the window frame. (4). 13. Wrongly glance into condit ion with which one is born. (10). 15. o harp for unfortunate child. (6). 16. Ceasing conservative procedure in dental practice. (8). 19. Hint for actor and billiard player. (3). 20. The reason for some families leaving home. (8). 21. Mechanisms check ing motion from bakers. (6). 23. Early procedure in brain surge ry (10). 25. 10vemen t of saint followed by the tax men. (4). 27. Limbs of those in the club. (7).28. An idea exercised the mind. (7). 30. Pains due to sudden, involuntary muscle contractions are not continuous. (9). 31. Venous channel in heart and dura mater. (5).

DOWN:

1. A cause of biliary colc. (9). 2. Venomous snake with a little spirit. (3). 3. Impl ement obtained by returning plunder. (4).4. Antisepti c provided by old possessive doctor und learner. (6). 5. Extend the Spanish on gate. (8). 6. Chair carried in France. (5).7. The girl who is trained to u se the ambulance equipmenf) (5.3.3.). 8. Sing as the Swiss and Tyrolese. (5). 12. Infection in which organisms are circulating in the bloodstream. (11). 14. Mineral increasing ones thirst. (4). 16. Rays forming Vitamin D in the skin. (3). 17. Twisted rope in opening of weat duct. (4). 18 Unusual gait stirs inflammatory condition of the stomach. (9). 19. Briefly continued second-hand type of wound. (8). 22. It makes one sick. (6). 23. Company with doctors producing honey cells. (5). 24. Terminal part of the small intestine. (5). 26. Chief protuberance. (4).29. Trap if spiril. (3).

SOLUTION TO CROSSWORD No.7 (73) This issue p. 17

ACROSS:

I. Cartilage; 6. La ss.o; 9. Puls e; 10. Sunstroke; II Tu sk; 12. Peril; 13. Sp.as; 16. H a ustus; 18. I ceberg; 21. Bee; 22. Nun; 23. Ureters; 24. Content; 25. Elan; 27. Limb.o ; 29. G.as.p; 33. Absorbent; 34. Heart; 35. Dandy; 36. Stretcher.

DOWN:

1. Ca.put; 2. Ryles's tube; 3. Idea; 4. Abscesses; 5. Ennui; 6. Late; 7. Stoop ; 8. Oversight; 14. St.eel; 15. Senna; 16. Hou semaid; 17 Set; 18. I ncubator; 19. But ; 20. Enema rash; 26. A.rs.on; 28. Il eus; 30. P.a ter; 31. Grey; 32. Shot.

Bright Lights and Open Spaces

NewComplan -:: tastes etter...

(lve tried it)

Mrs M Smythe of StHelens: 'I really enjoyed it. It seemed to teady my nerves and made me feel more relaxed. And mixing it \\'a ' smooth and easy- no trou bl e at all. '

You can recommend ew Com plan with new confidence. It will give your patients the nOUlishment their bodies need -the vitamins, minerals, protein (over 20 nutrientsl- in adlink they'll really enjoy. TlY some and see for yourself. It'll help you get through your busy day. And it's such good value for money: 3 heaped dessertspoonfuls (approximately 250 CalOJiesl make a nOLl1ishing drink that replaces a light meal -and costs about 5p!

A. Anatomical Teaching Models

The Brigade in Northern Ireland p.2

Where there 's hope there can be life by R. A Elson, MB, FRCS p.4

The Centre Lane p.5

A Home of your Own by R. L. Rihoy p.6

Around and About by the Editor p.8

At Random by Watkin W. Williams p.ll

The Throat by Dennis Clark, MBE, FRCS p.12

As Others See Us p.16

Hypothermia in the elderly by Arnold Shaw, MB, BS, DPH p.16

Readers' Views p 18

Order Investiture, July 19 p.19

News from Scotland - Wales p.20

Overseas p.21

News from Divisions / Centres p.22

National First Aid Competitions p.23

Edited and produced for the Order of St. John by DrIScoll Productions, 26 Pembroke Gardens, London, W8 6HU (01 -6038512) Editor : Frank Driscoll.

ADVERTI SE M E NTS DenniS W. Mayes Ltd 69 Fleet St., London , EC4 (01·3534447 and 4412)

Price 12p £1.70 per annum, including posta ge, from ReView Sales, St John Ambulance, 1 Grosvenor Crescent , London SW 1X 7EF.

COVE R:

Whi e viSiting Canada recently. the Queen, accompanied by the Lieutenant Governor of Ontario, sees Toronto Brigade membe r s M s. Rachelle Phillips, DIS nursing cadet division , and Hu go Sioos (Photo: The Canadian Press)

AT THE 1972 Brigade Finals Sir Keith Joseph kindly offered to present the Brigade with a cup to be awarded for Welfare. The problem is we at headquarters cannot find the best way to award this cup on a national basis. So we have decided to ask you, the prospective competitors, for your ideas on the subject in an essay competition.

1. The su bject of the essay , of not more than 2,000 words, is 'How I would award a Cup for Welfare'.

2. Entries to be divided into two categories:

a) Aged 16 years or over (no top age limit!) on February 1 1974.

b) Under 16 years on January 31 1974.

3. Essays to be typed or written in legible handwriting (one side of paper only), and sent to: The Chief Nursing Officer, St. John Ambulance Brigade, 1, Grosvenor Crescent, London, SW 1X 7EF; to arrive not later than January 31 1974.

4. Entries to have the word 'Welfare' written on the top left-hand corner of the envelope, and must be accompanied by the writer's name (Mr, Mrs, or Miss), Brigade rank and unit (Division, Corps, Area, etc.) or other connection (eg President, Auxiliary).

5. Entries in category (b) to give the writer's date of birth.

Those which do not give this information will be treated as category (a).

6. In judging the essays, credit will be given to ideas on the subjects, and only in the event of a tie will the quality of the essay itself be taken into account.

7. There will be a prize of £5 for the best essay in each category.

A second prize may be awarded in either or both categories jf the standard of entries warrants it.

8. Selections from the be t entries will be published in the S J Review Thi doe not mean that all the suggestions contained in them will necessarily be adopted, but the final decision will be influenced by suggestions contained in all the essays.

Here are some points we have considered: Should the cup be awarded to an individual, a pair (or larger team). Division , Area, or County?

What exactly houd the cup be given for?

What form should the competition take?

Should adults and cadet compete in the same competitions, or should there be two cups?

If the competition is not an individual one, what should a team consist of? And should we allow P residents and Auxiliaries to take part?

How can liminating competitions be t be arranged?

Would it be necessary for the National Finals to be held in the same place and on the same day, or would any other a lternative be possible and ati factory?

And most important have you any brilliant suggestions that are not touched on by the above queries?

H ere's yo ur c h ance to te ll u s h ow to awar d a tr o ph y.

The Brigade in N . Ireland

H O W FA R ES THE B R IGADE in the tragic events that have taken place in No rt h ern I re lan d over the last few years?

A t h e las t cou n t (197 0 ) the Brigade had 2, 465 m e m ber s t h e r e (3 45 ambulance, 657 nursing 404 amb u lance ca d ets and 105 9 nursing ca d ets) in 12 a d ult and 53

ca det d ivisi ons. All of these members

hav e b ee n an d still a r e giving continual servi ce i n p u blic d u ties, and very few of th e m h a ve n ot p e r fo r med some individual f irst aid d ir ec tl y or indi r ec tl y, in riot situati o n s a nd b o mb i n cide n ts.

S n ce h e tro ubl es sta r ted there have b een 2,8 00 exp losions, mo r e than 750 d eaths, a nd t ho u san d s of peop l e have be en i nj ur e d

T y p es of cas u al ti es d ealt w ith by Brigad e m e mb e r s r a ng e fr o m t hose suffe ring f r o m t e ar gas to a ll k ind s of inj u ries, including m ass mutil atio n They have

been involved in dea ing with relatives of the injure d an d the dead, the recovery of bo d ies, h e l ped in the collection of human remains in an effort to establish id entities, and ir mi:1or and major incidents throughout the country including the Abercorn disaster (for wh i ch two nursing cadets were awarded the Life Saving Medal of the Order), Bloody Friday in Belfast, and Bloody S un d ay in Londonderry.

Here is an example of an evening's d u ty at a SJ A first aid post. It is February 7 A one-day strike has taken place. I n the early evening, crowds of youths roam the streets of East Belfast. Serious street fighting breaks out in several parts of the city The security forces are stretched to the limit. Then indiscrimina te hooting, arson and looting develop. At the end of the day 5 people are dead, scores injured.

The officer in charge of the first-aid post reports 32 casualties deall with , apart from minor cuts and bruisep; seven of the injured have been sent to hdspital.

The Brigade operates 9 ambulances in Belfast, one each in Londonderry, Newry, Dungannon and Ballymena They have all been involved in incidents during the disturbances, while those in Belfast and Londonderry arc in constant ervice (and are usually referred to in news report s simply as 'ambulances'). These vehicle s bea r scars from road debris bullets, stones and other missiles ; one had the blue Dasher shot from it s roof. Keeping ambulance and their equipment clean after an incident-packed call-out m ea ns much scrubbing so as to be ready for th e next call.

Casualties among St. John member s have been remarkably few. There have

been c uts , bruises minor Injuries and the effects of gas; the most serious was an officer with a severe head wound which needed 18 stitches.

But their dutie s have been arduous. One Belfast division wa s on continuous du ty n a vul nera b le a rea for 34 hours , and during that time the superintenden t's home was burnt out by a petrol bomb A Belfast member who is an ambulance driver for the Hospitals Authority , drives a Brigade ambulance during his time off.

The wear and tear on Brigad e equipment has been heavy , and mu c h of it has had to be replaced. Three ambulances were re ce ntly replaced with funds raised locally, and London Distric t generously gave them two more vehicle. The Chief Commander Sir William Pike visited the Brigade in orthern I reland a year ago and arranged for a special grant of £2000 to be divided among division s most effected by the disturbances and £ I 000 for the Association fund For , understandably, more and more people there want to take first-aid classes: in Belfast alone in 1972, Association first-aid training increased by nearly a half over 1971.

St. John's 2,500 member in orthern Ireland, Protestants and atholic, are proof that citizens can work together con tructively in that co untry of civi l u nre t.

Bluebell Bar - 4 hospital cases and 10 treated on the spot. St. John's Mr Ryan and a member of the mobile first -aid party. (Photo: Century Newspapers)

Where there's hope there

-

can be life

by R. A. Elson, MB, FRCS

IN GENERAL, it may be ruled that the first -aider, on finding someone apparently dead, should not presume to make this diagnosis but should p erfo rm resus citative measures until the arrival of medi cal aid. Even a cold body can be alive; even widely dilated pupils and pulseless ness can be restored, as has been th e ca se in several incidents widely publi cise d by the media.

This opening statement is made in order to ensure that the first-aider should know his role in this unpleasant situat ion. The manual instructions and squad practice ensure that the qualified man or woman can adequately fulfil the necessary measures to maintain cardiac and respiratory function. There are exceptions, of c ourse : no-one suggests that the corpse dragged from a river bloated and cyanosed should be so treated - such cases will be obvious; whenever not obvious, treat the corpse (as it may be) as if in a condition of collapse , without delay In order to sho w how difficult this problem may be, even to experienced doctors with up-to-dat e equipment, some short account may b e of interest.

Popularly, death occurs when th e heart stops This mayor may not b e tru e - the same could be said of any argan For example, the kidneys , if damaged , as can occur in severe shock, can cease to function As night follows day, unless they recommence functioning or t h eir action is performed artificially by a machine, the patient mu st die. De ath would take longer to occur, h o w ever, than is the case of the stopped he a rt. Death does not occur until the brain di es and this might occur in kidney failure as a result of the heart stopping due to chemical poisoning , normally avoided by kidney function.

Thus, death from heart failure lead s to brain death and there is a definite in te rv a l of time between these two events - a matter of a few minutes. Death from kidney failure may take days but is just as inevitable and again occurs when the brain dies, secondarily perhaps to heart failure.

This would suggest that death can be defined as a state only reached when the brain dies. There is, however, a more difficult aspect of the situation: following 4

Time taken for complete death Fi[st event to occur

Four minutes Heart stops (eg. on e ectric shock)

Da ys Kid n ey failure

Ylonth or years Head injury

a h ea d injury, there ca n be such extensive br a in d a mag e that t h e patient is completely unc o nscio u s a nd there is no evidenc e on m eas u ring the e lectrical activity (t h e el ectro-encepha ogram or EEG) of br ain f un ction; an d yet, the heart respiratio n , and other vital functidns may continue. The doctor may know that the br ain cannot recover but the bod y re main s al ive. Such a vegeta tive state, as it is so m eti me s known, has occasionally laste d for years, nurses and do ctors patiently tending a living corpse.

A seri ous et hi ca prob lem is presented, especia ll y if respiration has been paralysed an d is maintained only by a m achine. The doctor is faced with the dilemm a of knowing that recovery is impossible and yet the decision to turn off the ma chine is so difficult to make

Th e re a r e m any ot h er problems which make the sHu a tion one to be tackled only by doct ors, wh o from thei r training have a ba ck ground knowledge an d experience whk h will e n a bl e them to d eci d e when resus ci tation s hould be stoppe d This experience is required most ly in th e ac u te situation in whi c h secon d s count.

For example, so meone has a heart attack and is pul seless ; the seco nd s tick away and, if oxygen su ppl y is n o t restored to the brain, it will di e within about four minutes. Adequ ate cardiac massage and a rti fic ial re spira ti on ca n sustain th e br ain and allow the heart t o

a l ive for many hours, gradua ll y succumb in g. With out the co-o rdinating mec h anisms provided by th e nervous system, s uch solat e d life is vulu eless, of course.

Some peop le regard death as occurring at the point in time when some irreversible eve nt occurs which mu st eud to death of th e whole organism even this wide definition cou ld be mi s int e rpr e t ed after all, birth is an irreversib le s tep which initiat es th e life cycle which ends in death Thi s sort of philosophical argument, so far-fetched, is the sort of state we can reach on attempting to define death. It is not th e ort of thing to be considered during the acute emergency Jnd, for the first-aider, he c lear rul e laid down in the first paragraph is all that need be considered.

Circu latory Brain death fai lure

Accumulation of poisons in blood st rea m .j, Heart failure Brain death

Brain death Yegatable state (terminated by pneumonIa or by stopping an artIfiCIal machine respirator)

Ambulance Member Trevor Haskins, St. Julians Division, Newport, Mon, is in

THE CENTRE

recommence beating. The patient may recover and be normal aguin for many years. If bram damage has occurred, however, this may be sufficiently severe to be irreversible and grossly disabling, even amounting to the 'vegetable state' mentioned above; the doctor may recognise the futility of further resusci tation and allow nature to continue h er inevitab le course.

I n another case, the doctor may decide not to resuscitate the e ld erly infirm person or one suffe ring from palllfu] in curab l e diseuse These are medical decisions based on experience Jnd a profound ethica l sense inbred in all doctors , rarely to be questioned, so powerful are the motives invo l ved.

I n th e urgent acu t e phase when the seconds count, th e main trap s which result in a mistaken diagnosi s of death are :

Hyp ot h er mia ( l ow body temperature due to exposure)

Narcosis (due to poisoning by drugs, gas or a coho l )

Shock (severe s ho ck can resu lt in a death-like sta te with no apparent circu l ation)

All of t h ese ca nnot be diagno se d without facilitie s o r expe ri enc e not avai lab le to t he first-aider.

It must be rea li se d that, even after death of brain and heart , the ma sS of individu al ce ll s of th e body muy remaIn

LANE

ON MOTORWAY M4, some 5 miles east of Severn Bridge, at about 9.50 pm.

We a ther co ld and just stoppe d raining; very dark , road surface wet, visibi lit y poor ow ing to spray on wind creen from passing vehicl es.

Travelli ng w est tow a rds New port at stea dy 55 t o 60 mph, and gaining on a car doing about 50 mph in centre lane. Flash llim a warning, but he s tay s in centre lane

I am in no hurry and in the e con ditions de ci de to reduce peed and move to nearside lune Almo st immediat e ly a whjte car passes me to stay behind the other vehicle in centre lane. Several curs then ]las both OIl the outside l ane. A coach, with all its in , ide lights on, passe me an d stays behind the other two vehIcles in the ce n tre lane. I do not pay much attention to the three vehicles ahead now as I h ave reduc e d spee d to a bout 45 mph and the trafric is moving quite normally.

I come over the brow of a hill and

see a co nfusion of lights ahead. I cannot make head nor tail of them, and then realise it is the coac h over-turning. I reduce spee d pass the over -turne d coach, and park in front of two other cars that have stopped on the 'ha rd-shoulder'.

I te ll my daughter-in-law and my wife, in the back seat, not to get out whatever happens. I ask my son to come with me to see if we can help.

At the sce ne we find chaos. The coach is lying on its side, across the centre of the motorway partially blocking the fast lane. People are lying on th e ground, so me c limbmg out of the coach, others trapped inside.

We h elp to get all the passengers out of the coach, except one, who is badly injured and trapped.

There is no other first-aider availab le, so ] ask two men to tay with the trapped casualty, my son to go among the casualitie to organise help, while I check those lying on the ground. They are cattered over a wide area.

I find one by the coach, a man, dead; one dear old lady trapped by her legs under the coach; one with suspected pinal injuries; one ba e of skull frJcture; o n e su spected fracture of ribs and scrotum; one suspected fracture of skull, unconscious; two unconscious but with no apparent injuries e:\.cept cuts. There arc 27 walking CLI ualties with various cuts and injurie

More cars have now s topped and driver s come over to assist. We go back to the lady trapped under the coach,

organise help to lift the vehicle an d ge t her clear. Attend casualty as b est I can. Have no equip ment , only coats, belts, cardigans, anythin g I can get hold of. I ask my son to get all the walking passengers wh o cann o be of othe r assistance to go onto the centre reservation t o warn us of approaching vehicles from eithe r dir ection At this very moment a car approaches at s pe e d an d hits the bus head-on, narrowly missing my son an d so m e of the passengers. The lone driver cli mbs out apparent l y uninjured. I notice a car has pulled into the centre of the motorway with its warning lights flashing. Two men and a girl get out. I go over; they are medical stu d ents an d a st ud ent nurse. Help has arrive d I give them details of casualties and suspecte d injuries. On e stu d ent atten d s the casualty in the coach; the other treat the lady who had been trapped by the legs; the nurse checks the othe rs. I then get some men to help fetch seats from the coac h to use as stretchers an d for itting on. A constab le arrives in a panda car an d starts org anising warning lights. Then ambulances begin to arrive. In one is a doctor. I report all I can to him, then help to lo a d the ambu l ances. There are now 7 ambu lances on the cene, so w e decide we ca n 't be of any more assistance. We report to the consta bl e (who' d d one a wonderful job); he thanks u and sees u across the road to our car.

ow I know why I have spe nt year learni ng fir t aid.

A motorway night inci dent (Photo : Hemel Hempstead Echo)

AHome of your Own

HOW GUERNSEY 'S NORTHERN DIVISIONS GOT THEI RS

by R. L. R ihoy , Staff O fficer

THE GUE R NSEY Northern Ambulan ce Division was formed in June 1940.

O ff icial application forms for registration at H eadquarters left the island on what w as to be the last mail boat to leave Gu ernsey fo r Britain until the end of the German occupation, five years later. The is land's Northern Nursing Division was formed d uring October and November 1940. So we have the unique distinction of being the only two Divisions formed u nder Ger m a n occupation!

The two divisions have always met on the same evening and co-operated in each other's activities, fund raising expenses, uniforms and equipment. During the war, of course, things were not easy; we met in various buildings, the last being a skating rink, and our uniforms were endlessly darned and patched.

But we never lost sigh t of one day owning our own headquarters In 1960 we started a building fund. After 4 years the fund had reached £1 , 000, £300 of it raised over 3 win ters by ambulance

THE BIG DAYOPENING

The Chief Commander

be

to the

by

and President of

Sir William Arnold ( left). Meeting members (below) outside their new 'home'. (Photos: Guernsey Press )

members cutting up trees for fire-wood. In 1970, a building investigating committee was formed and by the end of the year they had examined a sma ll sweet factory that was on the mark et. A concrete block structure with a slate roof measuring 55ft by 44ft , it comprised four rooms and was surrounded by grass-land. With permission from local authorities and London HQ , we d ecide d to buy it.

Our fund now stood at £ 1700 , another £4000 came from pooling divisional resource s, and a gift of £1000 was made to us by the Ba i liwick Central Committee.

We were half-way to our minimum required t ota so a deposit was paid to secure Les Gigands'.

1971 saw the start of feverish activity. Boards of Trustees and of Management were elected; loans and donations from our many friends were co ming in steadily, so it was decided to go ahead with the alterations n ecessa ry to convert the s weet factory into our headquarters. Plans were drawn and passed, and the work of digging foundations and building new toilets and a kitchen were given to contractors. The Division is lucky in having among its memb ers four fully qualified electricians, t wo painters and two builders so with the help of other members we were ab le to undertake mu ch of the work and so save hundred s of pounds.

We wanted to demolish the 9-inch concrete wall which d ivi ded the main building into two rooms and install folding doors so as to have one big hall when necessary. But unfortunat ely the wall supported one end of a stee l girder, which in its turn supported the upper floor! However, Area-Commissioner

Blan chfor d offered u s the gift of a 24ft. girder complete with folding doors, fittings and track, whi c h was redundant to Island Headquarters But the girder proved to be one foot too short! A lo cal firm Gu e rn sey Steel, came to our aid a nd exchanged our girder for a new one of the correct length.

Ambulance memb ers had already b ee n hard at work pulling down a c himn ey, wire-brushing the au t s ide w a lls and painting and decorating the two smaller rooms; they now set about getting the girder into position. How th ey worked

Evenings, at uruays, Sundays and holiday, for about I months. During thi penod the urs in g and Cadet Divi sions carried on their weekly drills among the nOI e, dust and chaos uncomplainingly .

Donations continued to come in , paying for the be t wood-block floor covering, eight built-in cupboards, gas cooker, Sink unll, six trestle tables, 50 stacking chairs, a wall clock, outside light. and two sign boards, one bearing the St. John Badge We had parking space for only ten car., but a patron made a field acro'iS the road avaIlable for 25 cars on a 25-year lease at [I a year

In 1972 a fund-rai ing committee, in cl uding DIVISional Presidents, was formed They bravely undertook as their mandate 'to raise £, 1000 per year for five years or until all loans are repaid whichever i the quickest.' Their activitie included tarting a Ladie ' F ootball Tournament which was so successful that it is now an annual fixture! By October there was a profit of .£ 1800, enough to pay the Interest due on the loans, and soon we were able to redeem bonds t o the value of [1500.

Additional work. to the HQ Included closlI1g the span roof with a suspended ceiling which greatly Improved appearance as we ll as conserving heat.

During August 1972, we were visited by Brigaue Staff Officer WlI1g- Commander Fazan and Mr. George Wood hill from London HQ, and were very thrilled when, as a result of their report, Wing-Commander Fazan returned in December and presented us With three sp lendid gifts from the Chief Commander 'in appreciation of all that had been achieved in such a hort time, and the money raised by our own effor t s without going to money-Iender.!' The gift were a large projector sc reen, un adult size R esusci-Anne and a R esu ci-Baby

So early 1973 found u in the happy position of huving c leared our debts and completed the work in three years Instead of the expected five.

Our Dedi cation Service and ope ning ceremony of the new HQ was in the Spring and attended by the Chief Commander.

After a lo ng but exci ting haul, Les Gigand s IS now a reality

Basle air disaster

came

opening, to

met

the Bailiff of Guernsey

the Council of St John,

Mrs Joan Worsley , a Birmingham mother who surl'il'ed the Basle air disaster, arrives back at LOl/don airport sellell weeks after [he crash. She was taken to the Midlallds by ambulance by TWO West COllmry dil'isional superint enden ts , Mr. Willam of Weston·super-Mare (below left) and Mr James of Cheddar, whose diJ 'islOl1s were closelv connected with the work caused bl' this (Photos: Bmningham Evening Mail)

CLI FF RESCUE

A doctor, 30 Brigade members and police were involved in a 4-hour cliff rescue on Guernsey during July. A 17-year-old youth from Cheshire fell 270ft down cliffs, and a Brigade man , with the doctor and two others, carried a stretcher 200ft down the cliffs on his back. The youth, badly injured, was taken to hospital.

FLYING HIGH

s t.-J oh n-takes-to-the-Air activities are really hotting up. As this issue of the Revi ew goes to press (August 8) already two headline-hitting incidents have occurred this month.

On August I, when the Spanish Government refused landing permission at Majorc a for an RAF plane to pick up 2-year-old baby Julia Purslow, who was suffering brain damage after falling from a holiday hotel balcony , the SJA Air Wing organised a medical team and equipment to fly out in a private plane

A few hours later, early on the morning of August 2, the Air Wing got a call at 00.30 to fly two kidneys from

A bow from the King of Norway See story: Head- in -air Joy. (Photo Mike Hawley, Camber ley News)

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST . JOHN

BY THE EDITOR

Belfast to London At 01 05, two Air Wing pilots, Mr. Stephen Broad of Barn et and Mr. W. H. Grimes of Bayswat er, took off from Elstree in Mr. Broad 's plan e. At 03.16 they landed at Belfast, a nd without even stopping the engines took off again with the kidneys aboard at 03.29 for London, where they landed at He athrow at 05.40. The kidneys were rushed to London hospitals by car.

This was the Air Wing 's 40th mercy flight this year. The Wing's volunteer pilot strength is now up to ] 08.

HEAD-IN -AI R JOY

Nursing member, air attendant and police 'special' Mrs J oy Longmorefrom whom I'd rather have a hug than be put into 'jug' - has just returned to her Camberley home after a 3-week jaunt which included helicoptering over Zermatt, getting a gallant bow from the King of Norway, and becoming front page Swiss news and full-screen on TV Wh at's this ambassadoring Bobby-ess been up to?

This whirl as Miss World - as Joy puts it - all stemmed from her being awarded the 1973 Internation a l Poli ce Association Travel Scholarship Th e subject she is st udying is the 'various systems of air transportation of casualties and patients', which will cover both helicopter and fixed-wing aircraft ambulances and rescue services.

Housewife and mother of two , J oy joined Frimley and Cam berley Division nine years ago after her first night duty as a police 'special' involved a stabbing incident - and there and then she decided that first-aid training was a 'must' for her.

Since atten ding the SJ A Medical Conference at Nottingham this year Joy , who speaks French, having worked in Geneva before her marriage , ha s been on a 3-week fact finding tour of Switzerland and Germany under h e r

Photo : Mike Hawley Camberley News

APPOINTMENTS

Gibraltar : Mr. J. Bishop , Dep. Ch icf Fire Officer, appointed Secretary to Council, vice M r. Edmonds Herts: to be Areas Commissioners.

North : Mr. P J Play er; South: Mr. F. H Stapleton.

Surrey : Mrs. C. M. Tremlett to be County Supt.(N) , vice Lady H ea ld

travel scholarship. She visited the Munich Air Ambulance service, whi ch uses helicopters for all types of accidents in the area or when medical aid is required quickly ; and she saw th e helicopters being built at the nearby Messerschmitt factory, which was also being visited by the King of Norway, who bowed graciously when he recognised Joy's British police uniform In Switzerland she visited the Sion centre of the mountain rescue se rvic e pioneered by the famous pilot Hermann Geiger, who was killed in an air crash in 1966. Using helicopters fitted with s kis , these mountain pilots fly in all weather among the Alps. J oy flew over the Z ermatt area in an ambulance helicopter. She also visited Geneva and Montreux, where she aeted as interpreter for the British section at thc Internati onal P olice Association's congress.

Nursing member , constab le, wife and mother, Joy is now back at her typewriter in Camberley preparing her paper on air ambulances , a vast subject which will undoubtedly play a major ro le in first a id over the next decade as the d eman ds on the SJA Air Win g i n Britain have shown over the last 18 month s. This is no h ead-ill-air subject.

THE CHIEF

A former Cheshire Western Area Commissioner , Professor E L. Edmonds has become Provincial Commissioner of the Brigade in Prin ce Edward Island, Canada, where he is the Dean of Education at the university.

A brother of the present Commander and Commissioner of Cheshire, Mr. Phillip Edmonds, Professor Edmonds is a Serving Brother of the Order and has published 14 books and many articles on education subjects. A sidelight on the breadth of the new Commissioner's interests is the fact that he is Honorary Chieftain of Canada's Mic-Mac Ind ians.

Everyone back home is delighted to hear of your SJA appointment, Chief.

GOOD FILM

For those who wi h to screen the occasional film of general interest I mList recommend The Living River , which can be hired from the Petroleum Film Bureau , 4 Brook Street , London , Wry 2A Y for 20p only.

Produced by British Petroleum and the BBC Natural History Unit , in colour and running for 30 minutes, this is a

CHAT TIME

14 - year - old Sgt. Karen Smith, of Derbvs' Alvaston Cadet Division, attended an injured motor - cyclist and took him to hospital and so was awarded the County cup for accident achievement, presented by Commissioner Col. P Hilton

delightful film sho wing the seasons' flora and fauna of the Riv er Test.

LOOK -SEE

London District's Mr. H E Burtenshaw, who was awarded a Win ston Churchill Travelling Fellowship earlier this year, recen tly returned from the Con tinent after two months studying ambulance services and disaster procedures.

Throughout his trip he had first hand experience of the method s used by working with the teams as a cre w member. In Heidleburg he spent one week at the Accident Research Unit, where he was on 24-hour duty and attended several accidents all of which were photographed for analysis. He was very impressed with the equipment in use in Germany, which is first class and constantly being improved; ambu lance

Time for a chat with juniors during the annual inspection of SJA Guernsey by Sussex Commissioner Prince Tomislav of Yugoslavia (Photos: Guernsey Pr ess)

work almost being a science to the Germans. He also looked into the use of the emergency doctor system, so called because each ambulance is manned by a doctor as well as two highly trained ambu lan cemen; and the emergency helicopter which is rapidly gaining favour as a means of transporting patients as fast as possible to hospital.

He has been invited by the German Red Cross to attend their four-yearly congress in Stuttgart next year.

TAPED

The Medical Conference '73, held at Nottingham University earlier this year, was recorded. Tapes or cassettes of talks are available at a modest hire fee from the Se cretary Visual Aids, London HQ County Secretaries have been informed of details.

MALTA VISIT

29 members of the Association and Brigade (and friends) from Wigan, Bolton Bruche and Warrington, visited Malta for a long weekend during the spring. They travelled by coach from Bolton to London, where their driver got lost, a taxi eventually piloting them to the A23, and they arrived at Gatwick with just 2 minutes to board the plane.

At Malta's Luga airport the party was met by Mr. Saliba, of District HQ, and the next three days were crammed with visits throughout the island, many of them as guests of SJA Malta. The trips included St. Paul's and Sliema bays, Mosta Church (with its magnificent dome), Rabat, the Hypogeum Temple the old Mdina, St. John's Cathedral and the Grand Masters' Palace.

As guests of honour at a reception held at District HQ Floriana, the party welcomed by the Commander, the Commissioner and Brigade members, and met Mr. and Mrs. Baker, late of Preston Q (Edward St.), who now live in Malta and wished to be remem bered to their friends back home. During the reception gifts were exchanged between Lancashire and Malta.

The party also visited Paola Divisions' HQ, and SJA Floriana organised a coach tour of the island for them. Three nursing members of Floriana, aged 16 to 20, would like pen-friends in Lancashire. They are: Miss Doris Cachia Daris-Sliem Triq Palma, Tarxien, Miss Baldacchim, 58 St. Phillip St., Gwaxaq, Malta; and Miss Margaret Farrugia, 67 By St Ulaldesca St., Pawle, Malta.

Returning to Gatwick airport on Monday evening, the party travelled over-night by coach to Lancashire where they arrived exhausted but having thoroughly enjoyed their short but memorable stay in Malta, thanks to so many of the island's SJA members.

10

A plaque of Wigan 's coat· of-arms from the Mayor (right) for SJA's Commander Malta Taking it are No. 4 Are a Commi ssioner Mjr. Choudhury and Miss Redford, Wigan Centre Secretary. See story: MALTA

Observer)

AVISITING

During July the Stores Department at The Gate was visited by Mr. Wilfred Wager, of 181 Bing Avenue, Willowdale, Ontario.

Mr. Wager helped to fo und the Birstall Division of the Brigade in 1903, and this is recorded in their Jubile e Handbook which was published in 1953. In 1910 he emigrated to Canada, but prior to this he was actively engaged in teaching first aid to miners and other people in the areas of Birstall Following his emigration to Canada, he joined the Association, where with Dr. Charles Copp, he assisted in the development of the Association as it then stood. In 1943, after terminating his services with the Medical Corporation, of which he was an active member, ending as a Ward master at the hospital at Niagara F a 11 s , h e j 0 i ned the Corps 0 f Commissionaires. His service to St. J ohn did not stop even then, for he proudly wore his badge and, indeed, encouraged the teaching of first aid.

Mr. Wag e r will be 90 on September 25, A new self-adhesive eye-patch - for children say the manufacturer s. It certainly looks comfortable than those with elastic round the head. I would have thought this one is suitab le for adults too. They should have sent me oneI'm suffering a painful 'shiner' after arguing with my car

his registration number on the bars to his Association Medallion is 86829, and the bars are dated from 1909 onwards, the latest being 1945. This indeed must be a unique record, and makes one wonder how many of Mr. Wager's contemporaries are alive today, when one thinks that 1903 i 70 years ago, a man's normal life span. Mr. Wager was 19 when he started to take an active interest in S1. John.

HOMES

Some readers have asked for details of homes run by the Joint Committee of the Order of St. John and the British Red Cross Society, 6 Grosvenor Crescent, London, SWIX 7EH. They are: Convalescent Hospital for Officer, Brighton (24 Beds) Open to ex-Service officers (men and women); wives and widows whose husbands arc or were ex-officers, serving and retired men and women officers, members, auxi lia ry members and permanent staff of the Parent Bodies or of the Joint Committee; members of the medical profession not already eligible as ex-holders of commissions in HM Forces who have given service in the Emergency Medical Service during the Second World War; and officers of the Merchant Navy.

The charge is £29.40 a week with a l ower concessionary rate of £. 19.60 a week for members and staff of the Order and the Society.

Scio House for Officers , Putney , SW 1 5 (25 Beds) A permanent Home for ex-officers of HM Forces. Present charge: £30.10 a week.

Ernest Burdon Hou se, Bournemouth (35 places) Queen Alexandra House, Folkestone (22 places). These two homes are for women members and HQ staff of the Ord er and the Society, and Registered women nurses and women on the permanent staff of the Order and Society not covered by the foregoing Present charge: £11.90 a week

FOR NEARLY SIX YEARS Lady Brecknock has been Chairman of the Review Management Board, With cha racleristic energy and enthusiasm she has throughout that period not merely enabled the Review to survive at a time some four years ago when its future see med most uncertain , but, after securing the appointment of our present Edi tor in January 1970, she has supported his efforts to present the Review in a new format and to make it what J personally believe to be a jolly good house magazine. But the time came when she felt she must hand over this particulur job to someone else, and it's only right that we should express in the Review a mo sincere th:lJ1k you for all that he has done for us during her chairmanship.

In accepting an invitation to succeed her as Chairman of the Board, I am very conscious of the need to maintain the high standards that she has et. The Review must go on being the kind of magazine that wIll attract an everincreasing number of subscribers from among our members and supporters because it give them what they're looking for and because they'd feel they were missing something vitally important If they didn't read it.

At a recent meeting of the Board, we discussed (a) what we thought were the objects of the Review, (b) how best to fulfil those objects, and (c) how to make it better known; for let's face it there arc some divi ions of which every single melllber is ([ subscriber, while there are others whose members don't even know that it exi ts So we decided four thing: (I) that we need YOUR views about what you think the Review ought to provide; (2) that we must be prepared, if necessary, to make quite sweeping changes in the form and content (and perhaps even the name) of the Review, to ensure that it gives you what you need; (3) that, without forgetting the needs of our older members, we must do a great dea I more to make J a reall y a ttra ctive and worthwhile magazine for our younger membcrs including cadets, since it's they who are the Brigade of the future; and (4) that we need more contributions (including photograph, drawings, cartoons, etc.) from our readers, and a really big drive to increa e the number of our , ubscribers

The success of such a drive depends very largely on local enthusiasm and by local J mean right down to divisional level, because the divi , ion is the most important unit in the Brigade and it's our really keen and live divisions that make the whole Brigade mechanism 'tick'. T wonder how many divisional presidents and vice-presidents read the Review Do yours? I f they do, tlley can be of imm ense hel p to us a ll by acting as local agents for the RevlCw and a channel of communication bet ween those of you who

AT RANDOM

insisted that his wife (who is also a Brigade member) took cover from the shooting before he went to help the wounded. Wh ether the whole terrible experience was more traumatic for Mrs. Lathwell or for her husband it would be impossible to say; but what one can say with absolute certainty is that in every respect he acted with the proper sense of priorities, the courage and the skill that we should all hope we might be able to show if we had the misfortune to be similarly placed, and that his sp lendid example is a further cause of pride and encouragement to all St. John members.

Dead Dates

by Watkin W. Williams Deputy Commissioner-in-Chief

read it and those who - aided by your contributions select and provide what you read

Review Discussion

By a lucky chance, the main theme of the Presidents' Conference (to be held at the Royal College of Surgeons in London on Saturday October 20) is publicity, and one of the main speakers will be Richard Baker of BBC TV. A discussion on the Review will be included in the conference programme, and we hope that presidents and vice-presidents will come up fully briefed to express your views and to discuss ways in which they can help us to carry them into effect. So please give them all possible encouragement to attend as your representatives! Application forms for the conference were en t to all divisions wi th the July issue of Brigade Orders and should therefore have reached all Pr e idents and VPs but if there are any whom they didn't reach through some breakdown in local communications, further copie can be obtained by writing at once to the Registrar, S1. John Ambulance HQ, 1 Gro venor Crescent , London SW X 7EF.

Terrorist Attack

Most of you will have read in the papers on August 6 of the unidentified Brigade member who heroically rendered first aid to victims of the terrorist attack on passengers in the transit lounge at Athens international airport the previous day At the moment of writing, it i too soon for me to be able to give details of exactly what happened, but I can at le3 t say that first reports were basically correct and that the ambulance member wa Mr. B. Lathwell, of the Vauxhall No.1 Ambulance Division, Luton, Bedfordshire, and that he ab olutely

I was sad to hear recently of an ambulance cadet who lacked but one more certificate to qualify for his Grand Prior's Badge, having repeatedly failed in Knowledge of the Order because he couldn't remember dates. Dates are no more history than clothes-pegs are fine clothing, but they serve much the same useful purpose. I write with special depth of feeling because for some years of my boyhood the subject of history was ruined for me by one master who made a habit of testing us by one -word answers, mainly on dates which - try as I mightI couldn't remember. Fortunately for me, history suddenly became alive some years la ter wi th the discovery that it's the gloriously unfolding saga of the story of mankind - heroes, cowards, saints and villains, kings and rebels, scientists, poets, explorers, and common men whose names were 'writ in water'. And there are few chapters in history tha t can be more thrilling to us than the history of the Order of St. John. May none of us ever be guilty of ruining its inspiration for our cadets by reducing it to a matter of mugging up a list of names and dates.

Bexhill

Accompanied by Lady Rosula Glyn (who has recently transferred to become a staff officer in the cadet branch at H eadquarters), I once again paid a very happy visit to Bexhill camp, an d my only regret was that I couldn't spare the time to be in camp for longer then 24 hours. Camping - good camping - is one of the most enjoyable and worthwhile experiences, which can bring out the best in all the campers and train that 'best' to become omething even better. It was a real joy to us both to meet 0 many of our younger members in such a happy and informal atmosphere, and I shan't easily forget the vigorous singing of the Liverpudlian contingent at the camp-fire If you want a cathedral we've got one to spare.

Wh ere?

Down in old Liverpool.'

Sincere thanks to Miss Willis and her cheerfu lly hard-working taff for carrying on the Bexhill tradition for yet another ucce sful ye3r.

VISIT (Photo: Wigan

Guernsey Nursing Division members donned SJ unIforms of 1890 to 1914 for a recent fete duty. (Photo: Guernsey Press)

The Throat

by Dennis Clark, MBE, FRCS

WHEN WE THINK of the throat only as a swallowing organ we overlook its significance to t he first-aider , for most of the time it is an essential part of the airway The part behind the tongue th e pharynx , is normally open and is closed only momentarily when we swallow . In the text books First Aid (3rd edition ) and The Essentials of First Aid ( 2 nd edition) , we are repeatedly instructed to 'ensure an open airway' and this has to b e done by attending to that part of the airway that is accessible: the thro a t To emphasise this the authors of Principl e s for First Aid for the Injured record that suffocation , usually from airway obstruction, is a major cause of death in the unconscious patient. New Advanced First Aid confirms this with statistics of road accidents and presents the ABC of resuscitation (Airway Breathing, Circulation) in wh ich the airway comes first. The American book Emergency Care follows with a similar ABCD and once again the airway comes first. It will thus be helpful to study in some detail the structure and functions of the throat the symptoms and signs of injury , and some of the more common throat abnormalities , thus bringing together information scattered through the text books

Anatomy and Physiology

The functions of the throat important to first-aiders are the passage of air , swallowing, and safety measures to prevent 'things going down the wrong way' Functions linked with voice production and modification of sounds in speech are not of significance to the firstaider.

The air channel starts with the nose, in which the air is cleaned , moistened and warmed for the lungs. With the throat at rest the breath is ducted from the back of the nose behind the soft palate as it lies on the back of the tongue , downwards through the pharynx behind the epiglottis to the open entrance in the voice box , then between the vocal cords, and so into the trachea The food channel is normally closed, lips shut and the tongue filling the mouth in front of the pharynx Below and behind the pharynx the opening to the gullet is closed by muscles arranged round this entrance like a purse-string In swallowing all these have to be altered into a food channel. The lips open and, be it noted, shut again after food has

FOR SWALLOW ING - YES, BUT ALSO AN ESSENTIAL PART OF THE EVEN MORE VITAL AIRWAY

p as sed. Th e teeth , aid e d by c

the nose is closed by

mu scl es lifting the soft p a lat e a nd pulling in t he sides of that part of th e pharyn x behind the nose At a low e r lev el the en t ran ce t o the voi ce box is clo sed by mu scl es c onstricting the a irw ay a nd li f ting th e whole voi ce box upw a rds under t h e b ac k o f the tongue At h e same tim e the e piglot t i s hing es b ac kw ar ds a nd downw a rd s fo rming a c hut e to d i rect t h e food into th e gull et. Thi s h appe ns because the purse -string mu scl e a t t h e gullet's entranc e r e lax es a nd allows a wid e opening to b e f o rm e d Ea ch p a rt o f th e food channel remain s op e n o nly l o ng enough to c ontain a nd pass th e fo od , then it closes again and th e airw a y o pens once mor e, in fa ct 'a e ve l-c ros sing '.

Symptoms and Signs

If any of these three fun c ti o n s , air conduction , food conduction and the provision of a s afe le vel-c ro ss ing ', go wrong the first-aider is deeply co n cern e d

When the function of swall o wing is disturbed in the t hroat ne a r the mouth , as in sore throats and from sm a ll sh arp foreign bodie s, the main sympt o m is p a in or even drooling sa liv a i f swall o wing is too pai nful. Luckily the pat ie nt will usually be able to br e ath e and giv e a good

BREATHING

(Airway open - gullet closed)

acco un t of wh at has happene d It is s ur p ri s ing h ow acc ur a t e y a fis h -bone can b e l oca li se d by the pain. Broad ly speaki n", if a patie n t po ints to t h e side of the neck a bo ve th e larynx th e bo n e wi ll be above th e l evel-crossing' on t h at side . If he p oi n ts ce nt ra lly or a litt le to one of ce n t r e it will be i n o r near t h e back of the to ngu e. If h e poin t s be lo w t h e larynx it will b e in the gu ll et. So m etimes the p atient will p u t a fi n ger into the throat fo r m ore acc ur acy, but any attempt to re m o ve o n e of these small sharp foreign b o di es t hi s way on l y causes more damage

Th e f i rst-ai d e r can te ll at once if there is n ee d fo r alar m by noting t h e breathing.

N or m al breathing denotes no immediate e m erge n cy, t h o ugh specialist medical attentio n sh ou ld be ob t a ine d q u ick ly .

All o th e r i nj u r ies to h e throat cause

va r yi n g d egrees of obstruction of the ai rw ay , from slight nuisance with co u ghing to severe asphyxia and death I n eac h case atte n tion is dra w n to the co nd i ti on by noisy breathing. The co mm o n est so u n d of obstruction to the air way is th e sno r e, mo r e po li tely called s te rt oro u s b r eat hi ng This occurs from th e sof pa late an d the back of the to ngu e. Du ri n g s leep it never becomes d a ng e r ous , for the sleeper wakens, but in u n co n scio u sn ess it is a sign of serious i m port as it d e n o t es airway obstruction

a nd t h e p atient cannot wake.

Ob s tru ctio n to the airway at o r be ow the crossin g o f th e t hr oat ca u ses a n other

SWALLOWING (Gullet open - airway closed)

characteristic s ound known as str idor' Thi s is a har d crow ng or w h isLling soun d rather like th e f rst ha l f of a d onkey' s bray, the 'hee' befor e the 'haw '. D iagnostica ll y it is of the utmost va ue to a do c tor for it not only ind icates severe obstru c tion to the airway but may also give one an idea of it s position in the airway. As a rule stridor on in s piration originates in an obstru c tion above the voca l cords , while s tr idor on expiration or 'doub le' stridor , mean s an occlusio n below A physician must have detai led know l edge of the c onditions caus ing stridor but a first-aider on ly need s to know that if it occurs th e patient is partia ll y as phyxiated and requir e s urgent medical attention. Wheezing sound s from l ower in the airway, common enough in asthma, or iginate other than i n the throat but they too indicate obstruction and must be notGd. Bubb lings, splutterings and rattling sounds often with froth at the lips are of serious significance In Principles for First Aid for the Injured a remark is made that froth on the lips is popularly associated with madness, rage and epilepsy, but it is really a sign of obstructed breathing. These are a ll the more serious when lividity of the face, b l ueness of the lips and nai ls are also noted , or when the hollows at the base of the neck and space s between the ribs a re seen to be sucked in during fran tic attempts at breathing.

The se signs and symptoms of airway occlusion c an alJ be seen or h e ard within a fe w seconds. Few are de sc ribed in the text books : only in P rincipl es for First Aid for the I njured are detailed descriptions given of them There, too, the view is expressed that a fir t-aider should so care for hi s c harge that bubbling sounds once relieved do not occur again

Injuries and Dise a ses of the Throat

With the recognition of s igns of airway occlusion in the throat comes the need to consider some classifica tion of the conditions that produce them Occlusion wi thin the airway often resul ts from blunt foreign bodies Blockage from outside is cau ed by strangling hanging and throttling Swellings in the walls of the airway not only include th e infections but a lso swe ll ing from scalds , c orrosives , crushes a n d reaction from hanging , strang li ng a nd othe r injuries after t h ey h ave appare n tly been re lieved Direct inj ur y t o the t hroat opens the subject of wo u n d s of th e throat. But perhap the m ost important and most freq uent conditions are those in whic h occ lusion is associate d with u pset of the safety m echan is ms of th e throat such as occ u rs in the unco nscio u s p at ie n t.

Foreign Bodies and Choking

T he s m a ll s h arp foreign bodies have been consi d ere d Jf l arger or smoother, th ey may ge t across the cros ing of th e

Rescuers

The Priory fo r Wales now has four inshore and b e ach res cue u ni t s operat ing on he We sh coast at Ferryside, Loughor, Barry and Car di ff, and is so helping to r educe the r isk s of those ho rrib le ho iday ac c id e nt s. Team s from these unit s recently gave a demon s r ation at Cardiff which was wa t ched by some 400 peop le, including the Lor d Mayor of Cardiff. ( Photo s: Western Ma il , Cardiff)

Gi r ifegua rd s from Ba ry 0 n a beach rescue

F e rry si de n s h o e es cue team u se a n o u t b oa rd inf lata bl e

THE 'LEVEL CROSSING' OF THE THROAT

The Throat (contd.)

Airport Disaster

throat and be caught in the gates of the gullet or voice box and cause choking.

It is necessary to remove large or soft substances if they are not too far down such as debris in drowning or dentures.

The diagrams in First Aid and in The Essentials of First Aid show how to do it (in either, the first-aider's finger might receive a nasty bite). A stick or a spoon handle (on edge) between the teeth enables a forefinger to be passed gently backwards beside the tongue to the side of the throat possibly behind the foreign body and so hook it out.

When the foreign body occludes the airway distress is extreme and fran tic efforts in coughing are made to dislodge it. At this stage the force of gravity must be used to help ; an adul t should lean forward or be placed in the recovery position and a child held up (if necessary by his ankles) with his head hanging down. At this stage the distress is as much due to spasm as to the foreign body, and thumping of the back may not be successfuL With the onset of cyanosis and un consciousness spasm will relax and thumping can even at that late stage be successfuL In Emergency Care the point 14

At 2 1 .30 the message came through: A Britannia, with 25 passengers had electrical and fuel trouble and would attempt an emergency landing at Stansted airport; police, fire and S1. John am bulanc es stand by!

As the cripp l ed aircraft l anded its pilot lost controL It hit a house, then a parked Comet both of which caught fire and before coming to rest its undercarriage collapsed. Stansted had a major disaster.

At east, what could be a major disaster, for this cene of blazing wreckage and screaming casualties was in fact the monthly training session staged by the Aviation Fire Training School at Stansied with the help of S1. John Ambulance.

This co-operation in training all stemmed from the training school's chief officer Superintendant W. Martin chatting to Derek Clark, the deputy senior flight controller of the S1. John Air

Wing. The training school was having difficuILies in getting enough casualties for their training session, so Derek Clark stepped in.

Some 50 SJA casuallies mostly from the Bishop's Stortford arc;), first attended the ses ions; but more were needed. London SJ A HQ suggested SJA Essex should provide the strength.

The July training session had St. John members there in force, complete With six ambulances from Harlow, Ware, Chelmsford, Epping, Dunmow and Saffron Walden.

These exercises are as realistic as possible. They are at night ;)nd it is quite a spectacle to see an old Comet go up in flames, as the fire-fighting appliances and ambulances race to the scene.

hospitaL Each must be checked against the passenger list. The ambulances are loaded, and a shuttle service begins.

On one exercise a passenger went berserk when he was removed from the aircraft; he had to be forcibly restrained and locked into an ambulance. His acting, at night, among the burning wreckage, was almost too realistic. But on another exercise a casualty did have an epileptic fit in the aircraft and it took some time to convince the rescuers that this was not faked. This real casual ty was taken to the local hospitaL

As the firemen tackle the flames, the police set up their communications unit, the ambulances their casualty dispersal area. The rescue work goes on under the glare of arc-lamps quickly erected. 1I1Jured passengers require treatment before removal to SJ A divisions in the area are welcomed to participate in this exercise. Superintendant Marti n needs 100 casualties and more ambulances for each monthly exercise. How about making this one of your 'away' training evenings, with some members coming as casualties, others in uniform? Write to Essex SJ A County HQ

for details.

is made that mouth-to-mouth resuscitation must be attempted when breathing ceases for enough air may be passed round a foreign body to maintain life until surgical assistance is obtained. Even if the foreign body is pushed on into one lung, aeration can occur from the other.

Constrictive Injuries

Occlusion of the airway from outside its walls such a occurs in strangling, hanging or throttling is well descri bed in the text books, though they tend to leave out the early symptoms of extreme distress, struggling and frantic attempts at breathing and the progress to cyanosi , cessation of breathing and rapid death.

All books rightly direct the first-aider to remove the cause, maintain the airway, perform respiratory resuscitation if needed, place in the recovery position and watch until medical help is obtained.

Th e subsequent swelling of the throat tissues, a reaction to the injury sustained, is often overlooked but must be remembered after the immediate emergency has been relieved.

Wounds of the Throat

Such conditions as severely cut throats, wounds of the floor of the mouth and severe compo und fractures of the jaw present the hazards of direct airway obstruction from blood, vomit, or

saliva; of aspiration into the lung and of 11 destroyed safety mechanism of the throat. In addition, the ability to swallow may be lost. The patient wiLJ show ;)LJ the dlstress of choking as well as severe shock. The most speedy first aid I needed. To prevent aspiration the nght posture is wanted at once. In a minor ca e the patient can stoop forward :.lI1d support the Ooor of the mouth with the hand, but even in these it might be safer to use the recovery position for all patients suffering from any but the most straightforward broken jaws.

Seldom will a first-aider be faced with such a severe wound of the throat that both the airway and the great blood-vessels of the neck are damaged together. In such exceptional c(Jses the con rol of haemorrhage m;)y take precedence, but even then this can be done in the recovery position.

Swellings in the Tissues of the Throat

This group of cases pre ents import(Jnt differences in cause and treatment. They are often the result of constrictive and other injuries that have been relieved but a reactive swelling has come on later. They certain ly occur from corrosive poisons, insect stings, or in those dread infections, now rare, such as diphtheria, Ludwig's angina , oedema of the glottis and acute laryngo-tracheo-bronchitis (to mention a few of the more ternble)

Common to all thse conditions is partial asphyxia from blockage of the ;)ir channel, not only due to swollen linings but also from inflammatory debns formeo by secretions or sheets of destroyed linlllgs partially dried by the air b rea the 0 over thei r surfJces. The symptoms include stridor, blueness of the lips, and depression of the hollows of the neck and rib spaces on inspiration. Posture help little, the patient soon finds the least embarrassing position, perhaps raised or propped up. Medical assistance is urge ntly required and soothing measures needed at once. Ice to suck might help sc::t1ds in the throat but in infective measures steam tents (not mentioned in ursing) have been found to be life-saving Recent work has shown that in these conditions, moisture to keep the airw;)y ecretion fluid is more Important than oxygen. That IS why a humidifier on an oxygen ten t is so important and the two together h;)ve replaced the steam tent. It is therefore all the more important to get;) patient to hospital.

Paralysis of the Throat and Unconsciousness

The L1l1[d function of the throat, the provision of a safety mechanism, breaks down when the normal actions of the various muscles of the throat are affected. This may occur from paralysi (infantile

or other), or in spasm (as in tetanus), but most frequently in unconsciousness. This cannot be stated too often and must be learned by all fust-aiders In Principle for First Aid for the Injured, while owning to some exaggeration, the authors advise fITS t-aiders to consider the airway obstructed in all cases of unconsciou ness. In New Advanced First Aid It states categorically that unconsciousness i a killer because it gives rise to obstructed breathing. The causes of unconsciousness are well listed in the textbook, but what mu t be emphasised repeatedly is the result of unconsciousness airway obstruction.

The dangers are twofold: obstruction by displacement backward of the base of the tongue, and aspiration of saliva or vomitu The displacement of the tongue is taught and illustrated almost 'ad nauseam' in all recent text-books, but the inability of L11e patient to wake and correct this obstruction, as he would if asleep, is not emphasised. The first-aider, having placed the patient in a recovery position, extended the head, held the jaw forward and cleaned out the mouth, then noted satisfactory breathing, tends to feel he has finished hi aid but vigilance must be continued until the moment he hands on hiS 'h(Jrge to a ho pital or doctor.

After considering this subject in these terms it may seem superfluous to warn all first-aiders to keep drinks away from all unconscious casualties, but brandy is still wrongly being poured into the mouths of the unconscious. A first-aider must be adamant in preventing fluids being given to anyone whose afety mechanisms of the throat are out of order.

The throat has been considered in some detail, perhaps too thoroughly and too isolated from the conditions, such as asphyxia, in which it plays an important part. The essential instructions that help to save life are contained in the textbooks and this di cussion is intended to amplify those instructions, not to alter them, and in so doing help the task of life-saving first aid.

References : FIRST AID (3rd Editioll) 1972 NURSING (3rd Edition) 1969

THE ESSE TIAI S OF FIRST AID (2nd Editioll) /972

PRINCIPLES FOR FIRST AID FOR THE INJURED (2nd Edition) by H Proctor and P. S. London, Butterworth. Londo//. 1968

NEW ADVANCED FIRST AID b)' A. Ward Gardener and Peter J. Roy/ance, London. 1969

EMERGENCY CARE. Ed. bv Warren H Cole & Charles B Preston (7th Editioll). Butterworth. London. /972

As others see us ... .

FROM THE WAlSAll OBSERVER

The crazy antics and deplorable habit s of a large number of young people of today sometimes make one despair of the future. Tales of teenage violence, disgusting addiction to drugs an d a general disregard for law and order abound.

But, there was a refreshing example of activity at Beechdale this week which indicated that all is not lost; that among us there are groups of young people who have the will and the determination to avoid bad company and take part in activities which, not only occupy their spare time in a healthy manner, but also qualify them to be of some use wi t hin their community in the future.

O n Monday, seven members of the Beechdale Ambulance Cadet Division of the St John Ambulance Brigade receive d Grand Prior Badges and certificates, the highest award for cadets and one which has few recipients throughout the country.

What makes these awards doubly satisfying is the fact that, although the corps celebrated its golden jubilee last year, this is the first time such awards have been won in the borough.

At a time when youth generally is under critical observation it is extremely heartening to witness the dedication of these young people who have just completed four years of study, which invo ved becoming proficient in 14 subjects, anyone of which might easily tax the strength and pa tience of many in d ividuals.

The cry that boredom is the cause for most d elinquency is often heard , or that a l ack of recreational facilities force our youth on to the streets, where bad ha bits are acquired. This is rubbish, and the bo y s of Beechdale can prove it.

There is room for many more young people in the cadet d ivisions of the St. J ohn Ambu l ance Brigade where character an d usefulness are blended to produce useful citizens.

Parents shoul d note the success of these boys and be prepared to inquire a b out such organisations so that they may d irect their children towards such training and, thus, go a long way to ensure that they have every opportunity to avoid the juvenile courts and grow up as d ecent citizens

Ed it: And I must add , happy ones too.

hypothermia in the elderly

hyp o t hermra. Wh ere muscular activity (whIch ge nerates heat) is reduced, as in paralysis, Park in so ni sm o r severe arth riti s, owe red body temperatures may be found even in the bedfast person if conditions are s uffi ciently adverse. Certain drugs, especially the phenothiazines , not only affect temperature regulation but also reduce the patient's awarenes of co ld Alcohol, combined with hypnotics o r tranquillisers, has been known to lead to hypothermia.

Recognition of hypothermia

Mild cases of hypothermia, that is to say when the temperature is above 90°F , are unrecogni<;able unless the temperature is taken This should be done with a low reading thermometer placed preferably in the rectum; but if thi not practicab le, the axilla is more reliable than the mouth. The thermometer shou ld remain In the axilla for rive minutes.

Suspicion of hypothermiahould arise if the house feels co ld on entry or (if the patient is in bed) the bedroom is unheatec..l or inadequately heated

Hypothermia can occur even if the paticn t is lying in what should be a warm bed, especially when the patient's movement is restricted by arthriti or other pathological conditions. I r the patient appear mentally confused suspiCion shou ld be greater.

the shock it might produce bUl also because the co ld su rfa ce blood co uld act on the heart to cause arrhYlhmias and possibly cardiac arrest. The aim shou ld be a gradual rewarming with half-hourly monitoring of rectal temperature and of blood pressure so that the temperature ri es not more than 1°F every hour.

R ewarming from the centre outwards ('core' rewarming) has been practised with some success, especia lly in those s uff ering al 0 from barbiturate poisoning.

It consists of warming the patient's blood outside the body by mean of a cardio-pu lm onary bypass, or warming by peritoneal dialysis.

Pati ents with advanced hypothermia often need oxygen because of their reduced respiration rate. Intr avenous f luid s, adequate ly warmed, are often necessary a nd hydr ocortisone is given as a matter of course. Treatment of the underlying cause is necessary and as und etectable broncho-pneumonia is so often a comp li cation, broad spectrum anti-biotics are given. The late mortality rate from comp li cations is high.

P revention

sweet-ta lke d her general practitioner into going over his list and got the names of those as special risk that she had not heard of. There were a large number an d she an d the doctor d ecide d between them who needed regular visits in the winter. For the remainder, she and the health visitor arrange d friendly visiting by the Old Peopl e's Welfar e Council.

Th e district nurse was upset about this and determin ed to learn all she could about hypothermia and how to prevent it.

Causes of hypothermia

The underlying cause of all cases of hypothermia is, of course, low environmental temperature. Florid case of hypothermia arc sometimes seen when e lderly people have fallen and lain, unable to mov e, for several hours before being dis covere d , or when an e lderly mentally confused patient has been found wandering in co ld w eather.

The survey carried out by the Society of Medical Officers of H ealth sho wed however, that florid cases are rarely seen in domi ciliary practice. Nine of their subje cts had body temperatures of 92°F or below and non e presented the c hara cteris ti c features of hypothermia. Their houses fell col d a nd on specific questioning they admitted to feeling co ld It is known that old people seem o suffer l ess di sco mfort than young people when exposed to low emperatures. Th ey tend not to shiver but are le ss able to maintain body temperature than the young. There are a number of diseases whi ch can predi s po se to hypothermia , including those in which th e b o dy 's metaboli c rate is lowered, s uch as myxoed e m a a nd hypopituitari s m Any condition lea ding to uncons c iou s n ess s u ch as stroke or head injury can lead to accidental

IT WAS A co ld grey day in November when the di st rict nurse got a call from the general pra cti tioner she was attached to asking her to go to see eighty-two-year-old Mrs. Linda Laz enby, whose neighbour s were worried as t hey had not seen her about for the past two days. Being a conscientious girl and knowing that Mrs. Lazenby was vague, often confused and somewhat vertiginous, she went straight away. She was unable to g et a reply an d had no compunction about breaking a pane of glass in the kitchen window , opening it and clim bing through A s mell of damp , decay and unemptied chamber pots greeted her and both cats rubbed up against her, frantic for food. Mrs Lazenby lay on her ba c k at the bottom of th e stairs, her right leg twisted a an a ngl e that immediately suggested fractured neck of femur. She was conscious, but barely so and answered que st ions with grunts and mouthings. Her lip s were dry and her face puffed up. She felt very co ld and her pulse was 52. When she moved her the nurse noti ce d that the limb s w e re as stiff as though rigor mortis had set in. On the face of it, the diagnosi s seemed fairly clear. Old Mrs Lazenby had felt dizzy on the sta irs, or she had h a d a stroke , had fallen and broken the neck of her femur and had lain there for nearly two days, unable to get help. In addition to her other complaints, she was now suffering from exposure. When she was admitted to ho s pital a fractured neck of femur was confirmed, although there were no signs of a stroke. Her temperature was 87°F. and she died thirty-six hours later of hypothermia with bronchopneumonia.

The advanced case of hypothermia is pale, or, if cyanosis it; present, grey The skin, even in the normally warm axIllae and groll1S, is very cold to tOllch and when the patient is moved a remarkable rigidity in the muscles is apparent. The face is PLI rfy, the pa tien t is drowsy and the pulse and respiration rates arc slowed. Acute pancreatitis so often accompanies hypothermia that the doctor must look for it if the patient too drowsy to complain

Treatment

If the tempernturc is above 90°F the patien t can often be managed at home The surroundmgs must be warmed, any intercurrent In fectlOn must be treated and the patient should be under constant superviSIon. If the patient is living alone and no guarantee is available that the room temperature can be maintained, thell she IS better off in hospitaL as is any conf used patien t living a lone.

It is often sufficient to move the bed into the warmer living room for the period of the emergency, and to warm the house. Local authorities have at their dispo al variou types of heating apparatus and blankets

The developed case of hypothermia is an interesting treatment problem. As in shock, th ere is a peripheral va soco nstr iction and to disturb it would not o nl y mean a conseq u ent lowering of the blood pressure but a circu l a tion of co ld s urf ace blood t o the internal organ which the vasoconstriction h ad been protecting. Externa warming therefore sho uld be avoided not on ly because of

To return to our nurse, she now realised that l o wer e d body temperature in the e ld erly is common and should be looked for. The low -r eading thermometer she had been carrying was an important weapon in prevention of hypothermia and should be used frequently and properly. To be on the safe side it had to be left in the axilla for a full five minutes if it was to record accurately the temperature of blood in the axillary artery and thus in the deep organs.

She then went over the lists of o ld people she w as atten ding or had attended in the past an d noted especially those that were mentally confused, partially paralysed, arthritic, myxoedematous or otherwise at risk. She bullied, cajo l e d and

She an d the health visitor then looked at the type of heating and found that most of these old people still had open fires. Some of them cou ld barely manage to carry in the coal to keep the fire going and they decided on a long-term ai m to try to persuade them to go over to something easier such as gas or electricity, arranging for so m e of them to have a visitor from the Social Security people to have a supplementary benefit for extra heating. Tho se old people who could manage coal fires wer e encouraged to fit enc losed stoves so as not to let half the heat go up the chimney. It is fair to say that neither the district nurse nor the health visltor had a very high degree of success in persuading their old people to change their heating habits, but they were convinced of the need for change and they refused to become discouraged. They next looked at their old people's eating habits and for those who needed it arranged meals-on-wheels. Some were introduced to the D arby and Joan club and this served a triple purpose of providing companionship, a midday meal an d warmth in the wint er (thus reducing their f uel bills). They are now concerne d to start a day centre for the infirm elderly a nd with the help of loc al doctors, churches and voluntary organisations are well on the way to providing a valuable medical and social service. Th ey wonder why nobody had ever thought of it before.

R eprinted from District Nursing.

'Sorry I can't mow the lawn, dear. m helping Freddy with his first aid lessons'

Beechdale Grand Prior badge winners with D IS J Stout

With winter a r ound the corner

Arnold Shaw , MB , BS , DPH , dis cu sse s

LARGE DRESSING

from Dr R. Mel. Archibald, Assistant Surgeon-in-Chief

I wonder if I might seek the hospitality of your columns to obtain the help of Brigade members who perform public duties?

We have at Headqu a rters an Equipment Working Party which advises the Medical Board, through the Surge on -in-Chi ef, on various items of equipment passed to it for consideration.

For some months now we have been eeking a really satisfactory large dressing Before our search proceeds any further may we as k Brigade members h o w useful it is to have a l arge (say lOins x 12ins or more) dressing , how often would you anticipate using such a dressing, how would yo u lik e to sec ure i to th e casualty, and so on.

Please write to me at HQ if you have any ide as which you think will help us

HQ R. Mel. Archibald

BETTER?

from A. Chinn

I recently purchas e d a copy of F i r st Ste ps in First Aid and would refer to page 75 , the removal of a plastic bag fro m a chi ld 's face and quote Mary managed to tear th e b a g away from his nose and mouth'.

Sweating due to shock an d the open mouth in a n attempt to breathe would t en d to cause the bag to be drawn more closely to the skin a nd mak e removal by tearing imp oss ibl e. Pr ec i ous time would be lost in this operation, time that could mean life or death. Moreover it should not be forgotten that panic would prevail in the unfortun ate victim who would struggl e.

Would it not be b etter to try an d hold the ch ild very firm ly (probably difficult for a youngster) and pierce the b a g through the open mouth with a pointed instrument, a ball point pen for example, or a finger, provided that the plastic was not too tough?

This would allow air to enter, breathing would then be restored, panic allayed, the bag cou ld then be removed at leisure, or shou ld it be necessary to apply mouth-t o- mouth resuscitation this cou ld then be effec ted.

Manchester A. Chinn

SEEING THINGS?

from W P Leach , Superintending Clerk

I must say how interested I was to read (At R andom, Ju ly) about the black cat that was seen in the Mansion House whilst members of Chapter-Genera l were robing for the G enera l Assembly.

I must , however, doubt th e authenticity of this report, as neither myself nor a ny of my helpers remembers dressing this interloper and I can assure you that on thi s day of the year anything in the robing room th at mov es is very speedily an d efficien tly dressed in a Man tIe a n d S op ra V est.

Order of St J oh n W. P. Leach

HEAD-GEAR ..

from J. Vernon, Sergeant

In his lett er (Jun e R ev iew) co n cerning ambu ance cadet uniforms

Mr. Stre e t sta es that in 194 8 his division 'st ill wore the origin al uniform style', an d then goes o n to mention the Glengarry My recollection is that the o riginal hat was the Tam-o-shanter, which was replaced by the service cap as worn during the w a r by a rm y and air force personnel. This cap was al so worn by most adult divisions in our area during the war, as it was more easi l y put into a pocket or und er a sho uld e r s trap wh en tin-h ats were needed during air-raids.

Some time lat e r ca det s adopted the beret, again in lin e with the se rvice s. As far as I know o ur a d s never wore the Glengarry. Birmingham J. Vernon

TEASER from J Marshall

I was very interest e d in th e t ease r by George Ju kes (Around a nd About , June) which I so lv e d in c id enta lly - because I know or a similar puzzle th at is (I) so lv ed in a layout of 5 boxes horizontally a nd 5 boxes vert ica lly (2) h as 15 c lu es, an d (3) three 18

READERS VIEWS

Readers views and opinions, which should be sent to the Editor. although published are not necessarily endorsed by th e Editor or the Order of St John and ts Foundations Although readers may sign published letters With a pen -name, writers must supply their name and address to the editor.

clues are given from which the puzzle can be so ved by d ed uction.

Could Mr. Juk es say if this is a sta ndard pattern for this type of puzz e?

Southend J. Marshall

Mr. Jukes replie s:

I agree with Mr. Marshall that my teaser could be u cd as standard, as once the pattern is formed then various other topics and c lu es could be interchanged, not neces arily in the same positions, and then solved by a process of dedu ction and eli min ation.

Perhap s other readers know of puzzles as ociated with subjects of interest to Sf. J ohn.

INFO WANTED from C. W. Tozer

I am compiling a book on the In sign a and Medals of the Order of St. J ohn and am including a section on the medal issued for first a id efficiency by th e Ambulance Centres of the rormer Railway Co mp anies and by British Railways.

As I fee l sure that your exce llent publication is read by many R ailway (and ex- R ai lw ay) first-aiders lllay [ seek the cour esy or your columns to reque st any of your readers who may have the actual medals or information about them to get in touch with me.

I am particularly interested in the following:

I. Great We s tern Ry , any details of the 15 years service medal

2_ Lanes & Yorks Ry, details of the medal ribbon.

3. L ondon, Chatham & Dover Ry , any details.

4. L ondon & South Western Railway, detai ls of the ribbon

5. Metropolitan R y, any details.

6. Midland Ry, any details.

7. North Eastern Ry details of the ribbon.

8. South Eastern & Chatham Ry, detail s of the ribbon for 2 1 years service.

J Granville Close, f-fGvGnt, /lanls, P09 2TR C. IV. Tozer

THANKS

from Mi ss F E. Martin, Superintendent I h ave recently returned home rrom n 'ho lid ay' pl anned t o be spent at Min ehead. A few days arter arriva l at my hotel I suffered a co ll <lpse from a coronary thrombosis and was admitted to the intensive care unit of the Musgrove Park H ospital, Taunton, and l ater, as my condition improved, to the general ward, 25 days in a ll. Dur ing this time of serious illness I received the most

wonderful k ind ness from the Somerset St. J ohn Ambulance, thr ough the Taunton Divisional Superintendent Mrs Vernon, who visited me every day. r sha ll never forget those daily l oving ministrations and 1 am sure that they contributed to my present convalcscen si t ua tion.

I shou ld like to record my gratitude.

Eastbourne F. E. Martin

COMPS

from Mi K. D. Wils on Divis ional Officer

Thanks to Lilian R i ley (May Review) for comments on competitions, whi c h Workington Division endorses. This stood out at the North Regional Finals held at Crewe recently when the winners and runners-up were 'p rofessional' or semi-professional teams getting much time (off work) for practice. Our ambulance team are so busy with pub lic duties that they have difficulty getting a free evening for team practice, and of course they work in different places and some on shifts. But still we did well over 3000 hours duty la st year!

Workington

Kathlyn D Wilson

ORDER INVESTITURE

July 19 1973

AS COMMANDER (BROTHER)

The Lortl Wetbury, MC (Yorks)

1110mas lleory Thoma son, (Lane .)

Percy crnest Leslie root, (Devon)

Henry Watson, CBE (Cheshire)

Rex ll enry Percy, MBE (Surrey)

AS COMMANDER (SISTER)

Emma Frances Heather, Mr Clode, CBE (London)

AS OFFICER (BROTHER)

Fredeflck ll enry llingley, (Wores.)

Harold Smalley, SRN,·RM ,( Lan cs.)

Major Charles H enry James Chevis, RA 1C, (Army)

Lt. Col. John Coates, (Middx.)

Gerald Willoughby Birc h, (Sussex)

Charles Thoma s E lli s, (Staffs.)

J ohn Stuart ll orner, MB ChB, MFCM, DPH , Dill , (Middx.)

Lt. Col. Edward Le li e Spencer, D 0, OBE, (Su sex)

The Revd Canon Eric Saxon, SA, BD, (Lanes.)

Col. J ack Albert Brunt, AMB IM, (Hants.)

Clifford Woodco ck, (Cheslme)

Col. Douglas Stuart Paton, MBE , lB , (Surrey)

Teren ce Graham, FCA, (Leics.)

Brig. Richard Bearn Walker, (Durham)

Patrick Vi c tor Co lli e r, QPM, (London)

V-Adl. Sir Peter D awnay KCVO CB, DSO, ( Hants. )

Major J ack Schofield, MBE, TD, (l lerts.)

Lt. Col. Granville Reginald Arthur Brooking, (G los.)

Phi lip Henry J ohn Wilkinson, (Northants)

Ronald Graene MacBe t h, (Oxon)

Oswa ld Lithgow, (Norfolk)

Samuel George Radford, (Zambia)

Brig. J o hn Francis Desmond Murphy, Q HP , MD, FRCP DPM ( ll ants.)

Ian Macdonald Campbell, BSc EEng, F ICE, FS l n tT , (York s.)

Reginald James Ba sco mbe, (Soms.)

The Revd. anon Francis George Ri ce, (Devon)

Anthony lil es Denny, (Essex)

Ri chard 1ichael Hone , (London)

The lion Chri top her Walt e r Monckton, (Kent)

AS OFFICER (SISTER)

Ir is Mary , Mrs. Knight, MBE , (BrIStol)

Col. F lorence Mary Marsh , RRC, SRN, RFN (Wor cs.)

Julia Elizabeth, Mrs. Halford , (Leic .)

Jean May, Mrs. Ilodge, (Soms.)

Elizabeth Lilian ladcl e in e, Miss Perkins, MB, BS, DOb st, RCOG, (S us ex)

AS SERVING BROTHER

Tom Fox, (Cornwall)

Capt. John Samuel Byard Whit e, (Soms.)

TIle Rt. Hon The Lord Clinton, (Devon)

David Buckley, (Yorks.)

Fr e deri ck Dennis Fursman, (Devon)

William Robert 1ears, (Derbys .)

George Walter Fox, (Warks.)

Frederick William San some, (Hants.)

Griffith John Griffiths, MB, BS, MRCS, LRCP, BSc, (Derbys.)

John Arthur Vernon, (\Varks.)

Dennis Joseph Adam s, (Derbys.)

Fr e deri ck J ohn Smith, (Che , hire)

David Frederick King, (E sex)

James Ernest llunco c k, (Notts.)

Claude Henry Coxen, (Worcs.)

Harry Moxham, (Cheshire)

Raymond Bladon, (Derbys.)

Hubert [lenry Pe te r Joseph Thurgood, (Kent)

Iv or Walter Elston, (Bristol)

William Eric Coope, (Derbys.)

Waller Edward Gruce, (B ucks .)

Peter Marshall, (Derbys.)

Thomas Lane Tu cke r (London)

Walter Henry Knot t , (Derbys.)

Perciva Mnrk Lyle, (De von)

Edward George Cec il Pople, (Middx.)

Art hur Albert Edwards, (BrUo l)

Fr ank Stocks , (Derbys.)

Jack Francis, (Essex)

Vi ncent Ralph Walker, (Notts.)

Kenneth Walter Ryde Edington, SRN, Q , (Glos.)

Antony John Avery, (Hants.)

William Arthur Tarrant, (Bucks.)

Arthur 1110mas Le Page (Guernsey)

William Frederick George Hal e, (London)

Henry Col ton Giles, (Bristol)

Ra lph Edward Hearn , (Bueb.)

William David (Cambs.)

Edward William Bradnock, (Cheshire)

Albert Edward Pa coe, (Cornwall)

Philip Lander, (Cornwall) orman Townsley, FRCS, ( orfolk)

Harold Clement, (Derbys.)

AS SERVING SISTER

Stella C1ui. tin e, Dr. Candler, MB ChB, (Devon) Irene, ,\[rs. Blatchford, (E e x)

Jes ica, Mr s. Good, (London)

Shirley, [i s Goldthorpe. (Hants.)

Alice Elizabeth, Mr Calvert, (London)

Anne, Mr s. Pick, SR (Derbys.)

Aline Countess of Wharncliffe, (Yorks.)

Lilian, Miss Evans, SRN, SCI, (Yorks.)

Eileen, '[rs. Perkins, (Derbys.)

aney Eileen, In. Cook, (Bucks.)

Susan Harris, (Worcs.)

Elma, Carter. (Yorks.)

Gweny, Lxon, SRN, (Yorks.)

Ethel Bessie. Collin , (Derbys.)

ellie, Mi ss Haden , (Wores.)

Winifr ed Grace, Mrs. Starkey, SR ,(York.)

Ruth, Irs Bennett SR , (Yorks.)

Sybil Dor cas, Irs. Tuft, (\Varks.)

Ver a Hclen May. I\lr s. Wood (Bucks.)

Evelyn, Mrs Chuke, SR ,(Cheshi re)

Rebecca Carol, I\lrs. Chivell, (Cornwall)

Bessie, Mrs. Butcher, (Bucks.)

Stella Doreen, Mrs. Stevens, (Dor et)

Daisy Kathl een, Mr s. Row e, (Wilt .)

Emmie E izabeth, I\ lr s. Downing. (Worcs.)

Bertha, Teal, (Yorks.)

Annie, I ISS Flet che r (Yorks.)

'You've quite made Susie's day, dear getting your big toe nipped by that crab:

NEWS from SCOTLAND

The Barony of L ston

This barony (near Edinburgh), which later belonged to the Order of St. John, was presented to the Templars in the 12th-century and was often known as Old Liston, to differentiate it from Kirkliston, the church of which, to the west of the Templar property, belonged to the Archbishop of St. Andrews In 1298 King Edward 1's Welsh troops came to Liston from Balintrado (Temple) before the B attle of F alkirk at which Brian de Jay , the Master of the English Templars who ha d previously been Master of the S cottish T emp l ars, was slain.

In the records of the papal enquiry of 1309 into the Templars in Scotland there is mention of a chaplain of Liston, but fo ll owing the papal decree of 1312 which dissolved the Templars, the barony came to the Order of St. John, although not , it seems, until 1335 when a royal mandate restored to John de Wirkeleye 'the Master of the Order of the Hospital of St. J ohn of J erusa lem in Scotland', what was d escribed as the manor of Templiston near Edinburgh. J ohn de Wirkeleye had paid Balliol a large sum of money to get the manor back. After that date few references to Liston before the reformation can be traced. We know that in 1533 the Lord St. J ohn, Sir Walter L in d say, gave the lease of some lands in Ol d Liston to a George Inglis and that a long w i th other Hospitaller properties the barony passed to the Lords Torphichen

The property of Mains of Liston was ca ll ed Hallbarns The manor place of L iston was called Hallyards and the first Lo r d Torphichen died there in September 1579. H is widow complained to the Privy Cou n cil tha t the Earl of Morton and others had violently entered the house and taken possession of it with guns, pistols an d other arms when her husband was d ea dl ie seik'. She may have been queru lous in 1584 she was complaining that the minister of Torphichen was demanding stipend for which she said she was not liable but there was constant troub l e about H allyards (including fights in the streets of Edinburgh in which peop l e were k illed) and this part of the property passed out of the possession of the Torphichen family in 1619 , being granted to the Earl of Mar. 20

OF FORTH

The barony of Liston, west of Edinburgh Jn 1631 the third Lord Torphi chen sold part of the old barony to a James Inglis of Eastfield whose father had already acquired various parcels of land there. All these properties, co mpri si ng one fifth of the barony, were sepa rat e d from Liston to create a new barony of Ingliston, to be held immediately of the crown. It is difficult to trace the boundaries of Liston and of Ingliston but all the places shown on the accompanying map, except for those in bra c kets are definitely mentioned as belonging to the Order of St. John those underlin e d being parts of the later barony of Ingliston. A Court of Session case, which lasted from 1813 to 1818, involved this second barony. Thoma s Cranstoun· complained that Archibald Gibson was not e ntitled to vote as a freeholder of Easter Brigg s, a small part of Ingliston. The right to vote depended on the Old extent' of the land and a complicated memorial on the subject by Thomas Thomson has been edited by Professor J D. Macki e and published by the Stair Society (vol. 10 , 1946) From this it is known that the lands called East[ield (now ca lled ngl iston) were worth £10 ,000 in 1813 ; Foxhall (earli e r called Todshall) had recently been sold for £11,500; and Carlowrie was worth £30 000. These figur es reveal ju s t how fertile the lands of Liston w e re, but th e barony also included a detached portion ca ll e d Listonshiels in the Pentland Hill, about seven mil es south of the East Ma ins of [ng liston This , b leak co mpared with the rich lands of the main barony , used to form part of the parish of Kirkliston but in 1540 it wa s granted by feu to J ohn Tennant and his wi fe by th e Preceptor of Torphichen. Tennant, who

sophisticated and well-planned with extensive use of c ic c i ronic ;mcl computerised co ntrol s for the locati0n of s ta rr and vehicles.

It was obv o us to the party why thi s s tation h as th e reputation of being one of th e most modern and eff ici ent units in the British Is les.

The visit cu lmin ate d in a trip around the coast on the Flying Christine, the fully equippe d off-shore rescue laun ch.

Meeting at Guernsey airport (I to r) Dr Bignall, Div. Surg. (Pembs), Mr Hayes, Chairman, St. John Council, Pembs Mr Wal te rs, Airport Comm andant, Mr Henchm an, and Mr. Brown, PRO SJ Council, Pembs

The L ong Walk

To provide amenities for their new HQ , 12m e m b e rs of the Maenclochog Qu adrilateral Divi sion made a sponsored walk on Jul y 13 and 14 of 94 miles [rom Cardiff to Maenclochog and carried a stre cher bearing a new resuscitation doll supplied by the Pembs St. John Council.

Before the start the team and six marshalls were fed and put up [or the night by the Cardiff D ivision.

was an official of the household of Jam es V , had advanced sum of money for repamng the house and church of Torphichen. The Ord er of St. J o hn also owned land s called Muirhouse , which probably included the site o[ the present housing estate to the west of Edinburgh and the open ground to the north of the houses upon which a golf course now stands.

J H Calder MacLeod

WALES

To Guernsey

La st May Mr M R L. Ha yes, Chairman of the St. J ohn Council for Pembrokeshire, accompanied by Dr. J C. Bign a lJ , Divisional Surgeon, and Mr. Anthony Bowen, PRO Dew t o Guernsey to ill spec t the St. John 's Re covery and Beach Offshore Res cue facilities o n th e island.

Th e party was met at Guern ey by the Airport Commandant, Mr. J Walt ers, and Mr. H C. Hen chman who until recently was Pre sident of the Board of Administration for th e States of Guernsey.

Mr. H ench man i ntrodu ced the pJrty to Mr. H a rold Touz eau, Commissioner, and Mr R H Blan c hf ord, Area Commissioner. A detail e d tour of the L.lcilities of the island was arranged, start ing with th e h ea dqu a rt ers at Sl. Peter Port. This is one of th e most

Chief Supt(N)'s Conference 100 officers and members attended Lady Crawshay's conference at LianLinndod Wells. The guest speaker, Miss \11 Sale, MBE, County Staff Officer (Training), Bucks, spoke on L eadership Within the DiviS ion. This was a practical session which proved informative and instructive.

OVERSEAS

The A st. Chief Superintendent for Wales, Mrs G. Williams , pre ided. After lunch the Chief Training Offi cer for Wales, Mr. J. P H arries, arranged a

paper exercise based on The Role of the Brignde in the Community. There is to be a follow -u p on the result of the questionnaire at District/County level.

Canada's 2nd Project FA CTS 'lOW well un d er way

Ont ario St. J ohn Council's second Proj ect FACTS (First Aid Community Training for Safety), which opened in January of thIS year in Cambridge and Guelph, is well under way with 1,221 trained

The Workmen's Compensation Board or Ontario is again sponsorIng the programme and the Indu stria l Prevention A socIation is supporting it and recommending it to its member firms.

Th e or.lginal Project FACTS, sponsored and underwritt en by the Workm en's Compensation Board, Ontari o, was conduc ted in Orill1a , Ontario, and is the first such rescarch study undertaken anyw h ere In the world. I ts purpose w as to mea ure the effect of community widc first aid training on the accident rate During the three year duration of the project, 25% of Orillia's population s u cces fully completed first aid courses.

The programme has attracted international attention. Vi sitor from the

United Kingdom and ew Zealand came to Orillia to observe the project in operatio n

In Britnin, St. John Ambulance is planning to embark on a imilar FACTS programme adapted to their particular req uire me n ts.

The report from the Y ork University re team states that in indu st ncs WIth trong safety programmes 'first aid training can reduce accidents by 30% and that in industrial settings, it can reduce accidents by 20 %.

This second project aims at th e re earch res ult of the Orillia experiment and concentrate on training industrial and business employees 0111),.

Under tht: Workm en's Compensation Act of Ontario , each compnny with fewer than five employees must have one trnined in the Emergency First Aid COLirse. Companies with five or more emp loye es must train enough individuals in the tanda rd Fir Aid Course to cover

different work areas, all shifts, holidays etc.

F ACTS a sists companies in meeting these requirements but the main purpose is to traill all other employees in the eight-hour Emergency First Aid Cour e. York University will again handle the research and report its findings at the conclusion of the project whi h is expected to run for almost two years.

Industrie are being encouraged to have their own per onnel trained as instructors so that in-plant cour es can be con du cte d at times most convenient to both employees and employer. Already some 56 in tructors have been qualified in specia l w eek-en d co urse in the two cltles. Many of these are in-plant in truetor Three of the new in truetors speak Portuguese and will instruct in the language where this is required

Many companies have expre sed their enthusiasm for the project and the training

The ladies - plus Chief Training Officer for Wales J. P Harries - of Wales at the conference. (Photo: Marina Gallery)

News from Divisions ICentres

REVI EW CROSSWORD No.9 (73) Compiled by W. A Potter

ACROSS:

1. Intestinal parasite from water m0p. (8). 5. Commanding Officer with Sergeant-Major in charge derived from outer space. (6). 10 Fracture of neck of femur as the patient may describe it. (6.3) II An aid to success from broken seats. (5). 12 An increase in salary to get out of bed. (5) 14. Abrasion of the skin from part of a tree. (4). 15. Preserve a remedy for disease (4). 16 Patient in quarantine, but there is definitely no epidemic. (8.4). 20. Retrog rade changes occurring in an organ in later life. (12) 22. Teeth abnormally prominent in the upper jaw. (4).24 Pack away from south to west. (4). 25. From the right r e pel suff e rer from chronic infectious disease (5). 27. Hairs of auditory meatu s in extra giblets (5). 28 Egg production at rupture of Gr aaf ian follicle. (9).30. Stitch immovable joint of th e skull. (6).31 Aid I sent for inflamm e d gl a nd (8).

DOWN:

1 Main arteries below the knee. (6) 2 Broken post s producing drooping of the upper eyelid. (6) 3. Sm a ll part of week (3) 4 Therapy aimed at restoration of a patient to a u seful pla ce in society. (14). 6. Cavity formed by bones of the face and skull (4) 7. Strong, brawny physique (8) 8 In s trument for dr a ining the bladder in act three (8). 9. Trauma inflicted in the th e atr e (9.5). 13 Antiseptic initially from Scotti s h Univ e rs ity. (5) 17 Manner of speech of doctor with a waiting li s t. (5). 18 B es t id e a for endocrine deficiency disease (8) 19. Enema admini s t e r e d to emply the lower bowel. (8).21. Support for an injured limb. (6) 22. Packi ng cases for head l ess and limble ss bodies (6). 26 May carry one to the grave. (4). 29 Beard of corn (3).

SOLUTION TO CROSSWORD No.8 (73) ACROSS:

I. Graft ; 4. Tsetse fly 9 Le p.rosy 10 Ordered; 11. Sash ; 13 Congenital; 15. Orphan ; 16 Stopping ; 19 Cue ; 20. Evi c tion; 21. Br akes; 23 Craniotomy ; 25. SUr; 27. Members; 28. Thought ; 30 Spasmodic; 3 1 Sinus.

DOWN:

I. Gallstone; 2. A.sp; 3. Tool ; 4 Thy.mo.l; 5. El.on.gat e; 6. Sedan; 7 First aid kit; 8. Yodel ; 12. Septicaemia ; 14. Salt; 16 Sun ; 17 Por e; 18. Gastritis; 19 ConLused; 22 Emelic; 23. Co.mbs; 2 4. Il eum ; 26. Boss; 29. Gin.

National First Aid Competitions

Brigade Finals

Ambulance

Review

A Guide to Films

ST. JOHN REVIEW

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Suggested

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Anatomical Teaching Models

ST. JOHN

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Getting Together p.3

How Fractures Unite by R A. Elson MB, FRCS pA

Welfare Cup p.6

Tr aining Programmes p.7

Ar ound and About by the Editor p.8

SJA Guernsey's new recompression centre by R J. Herv e p.1 2 Ambulan ce Driving, Part I, by M. V. Moring p.13

Vi sua Aids p.1

Wound Inf ection, by Dennis Clark, MBE, FRCS p 16

Readers ' Views p.19

New s from Scotland - Wales p.20

Overseas p.21

News from D ivisions Centr es p.2 2

Books p 24

Edited and produced for the Order of St John by Driscoll Prod uctions, 26 Pembroke Gardens, London, W8 6HU (01 60385121. Editor: Frank Driscoll

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COVER:

Major General D S Gordon (cent re ), h e Brigade's new Commissioner in -Chief from October 1 , cuts the 25th anniversary cake of Cheshire's c adet ca m p at Penmaenmawr , N. Wales, which he visited during August (L to R) Camp co mmander, County Staff Officer (Cadets) (A) R A Fielding; Cheshire 's new County President Mrs M L Gib son; the then C- in -C desi gnate ; Deputy Commiss ioner J. Lawren ce; Cadets Donald MacKenze, of Macclesfield, and Caroline McMurdock, of Wilmslow

AT RANDOM

IN AFRICA

by Watkin W. Williams Deputy Commissioner-in-Chief

HERE I AM at ongoma, enjoying a few days' relaxation and holiday with my friends Drs. Howard and Carolyn Mowbray, who share the duties of District Surgeon and general practitioners in a remote mountainous region of KwaZulu , 70 miles from the nearest town But" I had better start at the beginning I left Heathrow on the evening of August 15 and arrived at Salisbury Rhodesia, the following afternoon. I was met at the airport by Colonel Don Grainger (St . J ohn Commissioner for Rhod esia), Mr. Orr (Commandery Secretary) and my cousins with whom I wa to stay for the next eight days. My first officia l engagement was to attend the six -monthl y staff conference of senior officers of the Com m andery and of the four Brigade Areas into which R hodesia i divided. The conference was held in the St. J olm HQ building, well situated near the centre of Salisbury , and lasted all the morning and (with a break for lunch) well on into the afternoon. My strongest impressions were of the enthusiasm with which St. John activities were being carried on in all sections of the community, the progress that was being made in both the Association and the Brigade branches, and the tremendous warmth of welcome accorded to me as an official repr e entative of headquarters.

One of the most exciting decisions made during the conference was to hold the first-ever Rh o d esian St. John Camp, and it was unanimously agreed that atten d ance shoul d be for all race and both sexes. The Commandery entertained me to a 'sundowner' that sa m e evening, at ( Continued on next page)

AT RANDOM contd .

which I had the great pleasure of meeting informally, in addition to those pres e nt at the conference, a large number of officers of the Salisbury Area and their wives or husbands, and this initial contact made it a great deal easier for me to get a general insight into their work and follow up in later meetings some of the points that arose during our discussions.

Busy week

A visit to Bulawayo involved me in a 300-mile ten-and-a-half-hour night journey b y rail, and a similar journey back the following night. The Bulawayo Area Commissioner met me at the station and took me to his home for breakfast, after which I spent the morning being shown round the various St. John HQ buildings and first aid posts and having meetings and discussions with some of the officers.

Sir Humphrey Gibbs (Knight Commander) and Lady Gibbs most kindly entertained me to a luncheon party at which the Chairmen of the Matabeleland and R hodesia Railways Association Centres were also present.

D uring the afternoon I was taken by car to the Matopos, 50 miles away, to see Cecil R hodes's grave on a rocky summit from which one of the world's finest views can be seen and which he chose for his final resting-place Then back to Bulawayo to a 'sundowner' at the home of Mrs. Daphne Fyfe, the Commandery Superintendent (N), where for about two hours I met a large gathering of St. John personnel from the Bulawayo Area , several of whom came to see me off by the train at 9 pm.

The rest of the week included interviews with the press, radio and TV a visit to Harare Hospital and visits to Divisions in the Salisbury Area including the very keen and efficient Indian (adult and cadet) Nursing Divisions and the large and flourishing African Ambulance and Nursing Divisions at Highfield and Mufakose, and it was a special joy to see the enthusiasm with which they were undergoing - and so evidently enjoyingtheir training.

At Mufakose, too, I found a group of nearly 20 prospective Ambulance Cadets who formed the nucleus of one of the first two African Cadet Divisions in process of formation in Rhodesia. But no mere catalogue of my engagements during that busy week can adequately describe the warmth of welcome that I received from everyone that I met , nor the splendid way in which, despite many difficulties, St. John personnel of all ranks and races are working together in the service of mankind.

From Salisbury it was a couple of short hops by air to the Kingdom of Swaziland, a country about the size of Wales and almost the smallest in Africa I

was met at Matsapa airport by Mr. Smithyman , the Commissioner, who took me to stay with him at Mbaban e (the capital, about 20 miles away) for the first three days of my visit, and I spent the rest of the week with the Bishop of Sw aziland and Mrs. Hunter. St. John activities in Swaziland are almost entirely limited to the very efficient training in first aid given to the Royal Swaziland Poli ce, all of whom are required to take an A sociation Certificate as part of their initial training and to maintain its validity throughout their period of service.

But I soon discover ed that there is immense scope for further Association and Brigad e work in the community, and more particularly in industry, if once it can be got going; and the contacts that I was able to make s uggested that this would receive considerable support.

One of the highlights of my stay was a most interesting visit to the Poli ce Training College; I also met representatives of industry and of the press, and had a very cordial and useful meeting with the Chairman of the Swaziland Red Cross, which is doing sp lendid welfare work for the relief of people in outlying areas who have been rendered homeless by forest fires.

And one last encouraging event of my stay was when I met the wife of an Anglican mission priest recently out from England, and foun d that she is a trained teacher and an Association member and had offered to teach first aid to her local community if the police could provide her with some equipment.

No tale!

You must all know the saying about ostriches burying their heads in the sand and imagining that they can't be seen.

The other day I passed two ostriches on the veldt , and as soon as they saw us they

ducked their heads to the ground, their bodies sti ll in full view, and every few moments o n e or other of them would shoot its head and neck vertically up a yard into the air to see if we were still there, and then shoot it down again. I t was one of the funnie t sights I'v e ever seen, a nd certain ly proved that the popular saying is no o ld wives' tale

First of spring

My present hosts and their children were spending a couple of days' holiday in Mbabane and they brought me home to Nongoma with them 190 miles by car, much of the journey along 'dirt roads' where every car raised a cloud of dust as. thick as fog.

We got here after dark , and it was a wonderful experience to go out in the morning and find oneself on the highest ridge for scores of miles with glorious views across mountain ranges JIl every direction, and then to sit out on the lawn in a garden with oranges, lemon, grapefruit banana , pawpaws and mulberries growing in it (but not all of them ripe ju t yeti). I can't pretend it's exactly hot certainly not compared with Rhodes13 because it's only just the very beginning of spring, and when the sun isn't shining the chilly wind or damp mist can make one glad of a pullover; but if" a lovely interlude in my St. John tour, and quite unspoilt by the fact that ['m trying to get rid 0 f the first cold tha t l 've had this winter!

In a few days' time 1 hall resume my travels, visiting two Mission HospItal s in Kw &Zulu where I 've stayed on previous occasions, en route for the HQ of the Priory for South Africa in Johannesburg ; then on to vi it SL John in Malawi, and finally what looks like being a whistlestop tour of the very extensive St. John activities in Kenya. YOU ARE THE THINK-TANK

Welfare Cup competition

We want your ideas in an essay, on the best way to award a Welfare Cup on a national basis:

1. Entries (max. 2000 words) to be divided into two categories:

a) Aged 16 years or over on February 1 1974

b) Under 16 years on January 31 1974.

2. Essays to be typed or written legibly (one side of pap e r only), and sen t to: The Chief Nursing Officer, St. John Ambulan ce Brigade, 1, Grosvenor Crescent, London, SWIX 7EF by January 31 1974

Getting Together

We're all in the same boat the convention's full strength cruising on the Thames

NEARL Y 200 young Brigade members from Canada, Germany and Britainaged from 16 to 30 attended the 2 week convention/holiday at the RAMC Depot Myt chett, during August. Nearly 100 of them were JUH members from Germany.

4. Entries in category (b) to give the wnter's date of birth. Those which do not give this information will be treated as category (a)

5. In judging the essays, credit will be given to ideas on the subjects, and only in the event of a tic will the quality of the essay itselfbe taken into account.

6. There will be a prize of £5 fo r the best essay in each catego ry A second prize may be awarded in either or both categor ies if the tandard of en tri es warrants it.

3. Entries to have the word 'We lfare written on the top left-hand corne r of the envelope, and must be accompanied by tne writer 's name (Mr, Mrs, or Miss), Brigade rank and unit (Division, Corps, Area, etc.) or other connection (eg President, Auxiliary).

As well as 2 hours of mixed training a day in first aid and allied subjects, this international get-together made various visits throughout the south of England. They spent a morning with the Army Air Corps, some members flying in helicopters; and later visited Stonehenge. Another day wa spent at the Airborne Forces Depot , where the Red Devils Free Fall parachutist team put on a display, and other parachutists demonstrated practice jumps from a balloon. The coast was visited at Brighton, Southsea an d Portsmouth whi ch included going aboar d HMS Victory in dry-dock. Oth er outings included Hampton Court, Windsor Palace and a steamer trip on the Thames; while a day in London took in the Tower, Westminster Abbey and St. John 's Gate. If members comments are anything to go by, this international St. John gettogether should be the first of many more, much bigger, convention/holi days.

Swaziland

With the Army Air Corps at Middle Wallop, where the re was a SJ Air Wing plane

The members from Germany having a good look at Stonehenge

At St. John's Gate. Secretary General N C. McClintock welcomed the members before lunch

How Fractures Unite

THE CORRECT FIRST AID

CAN CONTRIBUTE SO MUCH

by R. A Elson , MB FRCS

THE SKELETON is a rigid framework clothed by soft tissues. its constituent b ones, beautifully articulated so as to enable controlled movements, give length and form to the limbs, hold the chest expan d ed, protect the chest, skull and spina l contents, and house the marrow where some b l ood cells are formed.

A fracture disturbs most of these functions, and whichever part of the bo d y is concerne d , it can no longer work properl y without its intact supporting bone . T he union of a fracture is therefore of paramount importance. Further, if unio n should occur without the parts being properly aligned, function cannot be perfect although it is very remarkable how well the body can compensate for such inaccurate alignment, provided it is not too grea t.

First aid for fractures comprises a knowledge of how to diagnose the possible presence of the fracture , and then how to splint the part in preparation for transport. On arrival at a hospital, the first aid is completed and a more exact diagnosis is made using facilities only available in the hospital, notably radiography (X-rays). From the site and shape of the fracture, considered in association with the age, general health and build of the patient, the surgeon decides on the best course of management.

H is aim, an extension of the first aid, is to immo bilise the fractured bones, having brough them into proper alignment in all ways. The alignment is checked by further radiographs and is maintained until clinical examination and still more radiographs show that it is safe to discontinue. A period of mobilisation and protected use is instituted until the part has become fully restored in strength, and its associated joints are moving fully.

This is the story of fracture management, but, as always, it must be recognised that it is nature who repairs the fracture; all we do is to make nature's work more easy. The essential thing to achieve is, having aligned the fracture, to h old it still. Any movement slows the h ealing process and in some cases can result in a failure of the fracture to unite - non union, or a slowness to unite delayed union

Surgeons through the ages have sought to aid the natural process and, even today, the factors governing the union of fractures are ill-understood. Som e of these may be outlined however , and are of great interest.

Pai n

The pain from a fracture m ay be severe, but serves to make the subject refrain from moving or using the part. This is seen in animals in whom fractures can unite without any other treatment than that imposed by th e pain. Fr equently, the pain causes the muscles to contract around the fracture (spasm) and this prod u ces furt her immobility although it may cause overlapping of l ay bones and a poor position mal-union rna y result, with so me permanent deformity (Fig. 2a).

Swe ll ng

Always around a fractured bone, a swelling develop s. This is du e t o three factors: the escape of blood fr o m the torn bon e ends (fracture haematonia), local bruising du e to the force of the blow, and bulging of the soft ti ssue if there is o ver lap of the bone ends.

R es torati o n of proper alignment of the bone en d put, the s urroundll1g tissues back into ten sio n and help s o con tr o l the s w elling Keeping the part still, o n e of the main aims of fir t a id reduces the bleed-

ing and therefore help s to control the swelling as well as reducing s hock On ce aligned, the s welling help s to keep the bone ends pressed togeth e r into close contact; this is du e to the tension th e s welling ca u ses on the s urrounding soft tissue. Provided it is not excessive, th e swelling aids initial union of the fracture in these several ways. The blood c lot around the fracture ends is believed by many to be a st imulu s for bone for mation

co nfu s ion occurs in th e mind s of patients: one with a fractured tibia had a p laster , another had a n operation, another had both! Th e answer you ca n always giv e s that every fracture and e very patient are individual a nd ther efore treatment will vary.

On e of the mo s t r e markabl e facts is how fractures unit e d espite movem e nt (provided this movement is not too great).

b. T he fracture aligned but overlapping.

c. The fracture completely reduced and stable because the periosteal membrane is in part intact and the fracture ends fit well

Fig 2. Two ca uses of poor reduction

a. An oblique fracture tends to slide as shown. It may be possible to reduce thiS fracture but difficult to maintain the reduction

b A nerve has become trapped b et ween the fracture ends. Almost certainly, an operation would be required to co rrect this

Accu ra t e reductio n R ed u ctio n is the term u sed by s ur geo ns to describe the process of res toring alignment of the fractured bone e nd s. The d eformity is the thing which i r educed. Th e more accurate the re du c ti on, the cl o er d o th e bone fragment s lie together an d t h e more r ea dil y will h ea ling occ ur. Clearly so m e fractures can be redu ce d better than other. (Fig. I) Some are impossible t o reduce Without performJJ1g an ope rati on an d actually seeing th e exposed bones. In general, if operation can be avoided it is beLler but herein lies the ski ll of the s ur geon in first assessing the results of clo ed treatment and then deciding In any new case whether or not an operation is necessary. Many things aid reduction, especia lly if a part of the membrane which covers the surface of the bone (the periosteum) has remained Intact (Fig I) or if the bone ends are nicely haped and fit' each other.

Fi xa tion

(A)

) The periosteum

(B)

(8)

(C)

Th e final factor which will aid union of a fracture is fixation of th e bone ends an d maintaining thi s fixation for a suff icien tl y long period. Some fractures heal more easi ly than other; for exa mpl e, the haft of the humerus nearly always heal even Jf fixation is not very effective, whereas th e tibia i very prone t o nonuni o n if n ot properly held In general, h o w e ver, th e more effective th e fi xation, th e belLer are the c han ces of so und un ion.

Fix atton is ac hi eved by external o r internal means, and every fracture of any bone has peculiaritie whIch will influ e n ce the urg eo n in hi choice of techniqu e. Of the external mea ns, a plaster-of-Pans cas t or so m e so rt of sp lint , su c h as Th o ma s' for th e femur, a re w e ll known. Th ey a rc afe and efrective pr ovided the reduction of the fracture is maintained; it is no u se maintaining fixati o n if the previously reduced fracture ha s s lipp e d badly. It i in this ort of circumstance that th e urge o n m<lY decide to abandon external fixation in favour of opcmtive tr eat m e nt a nd internal fixation.

I n some fractur es, the fracture ne c k of femur for example, the surgeon may know from experience that external fixation is not effective and h e may decide to advise operative treatment at once. It is from considerations like these that

In s id e a pl as t e r with a re ce nt fracture, the patient can often fee l the bone enps nibbing s lightly ; over th e fir s t week or so, this sensation di sappea rs. The reparative process, in si mpl est terms, forms a splint round the bone en d s and across the little space between th e m , new ce ll s and fibres grow, joining them toge the r. On ce across the gap, the fibres sho rten , drawing the ends cl oser togeth e r an d at the sa me time the ce ll s change their function forming a substa nce ca ll ed cartilage. Th e carti lage becomes replaced by bone. ow th e fibres are soft, the ca rtilag e is fir m an d the bone IS hard, this progressive chain of increasing UNITED SJ FAMILY

rigidit y enab les the bone to take over the role of the plaster cast. If for any reason it is interrupted before the bone stage, delayed union or even non-union may occur. Int ernal fixation aims to provide a really rigid fixation and with modern techniques using plates o r sc r ews or rods, the rigidity is of a high o rd er. A remarkable feature of such effective internal fixation, assuming the reduction was good , is that there is very little e vidence of the steps of the union (fibrescartilage bone) having occurred - bone seems to have bridged directly across the minut e gap and the bone swelling usually seen around a fracture treated by closed methods does not occur. Successful fracture manag e ment can not be achie ved if the blood s upply to the bone en ds has been damaged too mu c h and it is h ere that early skilful and gent le first ai d can co ntribut e so much to the h appy o ut co m e sought by the surgeon.

Londonderry's Sion Mills Combined Cadet Division is a family affair, as most of the members are either brothers, sisters or cousins. Here are the McCrossan family members - eight of them - Geraldine. 15, Eugene , 13 twins Patricia and Carmel 11 Sean. 10, Brian 9, and tWins Kathenne and Isobel 8 (Photo: Londonderry Sentinel)

prompted a few remarks about a fire, to help dry the linen. Miss Annie would have probably said she's saving the coal fo r her sister 's bedroom; there's none for downstairs or money to buy more.

Miss Annie also comp lains of her feet and is pleased when the member suggests a chiropodist. Their talk then leads to the garden and Miss Annie's difficulties in cutting the lawn She is delighted when told perhaps a St. John cadet can help with the garden. Many dangers are apparent in the room a worn carpet, a trailing flex, an iron with an obsolete plug, a walking stick with no rubber ferrule all of whi ch the member could/should observe and advise on.

Judge's comments

Both she and the candidate immensely enjoyed the demonstration and they

Welfare Cup

AT THE 1972 Brigade Finals Sir Keith

Joseph gave a cup to St. John to encourage a greater participation in welfare. Since then there has been a great deal of discussion as to the best way to award the cup, resulting in the Welfare Cup essay competition announced in the Review last month. At the 1973 Finals one idea was demonstrated and those who saw it were asked to send in comments. Review readers may also like to comment on the test

The scene

The front room of the house of two -elderly sisters. One, Miss Annie, sits in front of an empty fire-place with an empty cdal scuttle nearby. On the other side of the room is a nightdress in the process of being ironed; on a airing horse is a rather stained, damp sheet and another nightdress. The breakfast things are still on the table and, as photo 1 shows, the room contains other hazards. A St. John member, who has been asked to call, enters.

On the card

A neighbour has not seen the Potter sisters for a day or so and is rather worried about them. So she has asked a SJA member to calion them to see if they are all right. In other words, to generally assess the situation and see what their needs may be.

The test (10 minutes)

The nursing member talks with Miss Annie, learning that her sister Emily is in bed with a bad heart, and that she herself has progressive rheumatoid arthritis and finds it difficult to get about. Her sister 6

made one or two relevant comments:

I Ten minutes is not enough time for the test particularly if the can didat e is hesitant.

2. This type of competition 'stretches' the co mp etitor more than the usual tests. Competitors need to be more observant, as it is not a straightforward question and answer session.

3. The competitior would prefer to do something rather than just talk, which tests the skills of com muni cation.

4. The judge needs to be skilled in questioning to preven long periods of silence.

5. An assistant judge is ne cessa ry, if only to tick off the points as they are mentioned.

6. A sufficient time interval between

WHAT DO YOU THINK OF THIS IDEA FOR A TEST?

Training Programmes-

tests to enable the judge to recall the entire ten minutes of conversation is essential to fill in the mark sheet.

Conclusion

This was an interesting experiment which pin-pointed some of the difficulties of a welfare test. It required of the competitor common sense, tact and the ability to talk to someone in need; a knowledge of what services are available and how to obtain them - it is no good just saying ' we can arrange that'. The competitor must know what St. John can do and who can advise the helpful neighbour for other things If you saw this test and thought it was easy - how many of the deliberate mistakes did you spot?

tends to be incontinent and Miss Annie cannot get to her quickly with a bed pan when she calls. Their talks leads to the problem of getting the washing don e, dried and ironed, and help that might be available. Dirty crockery on the ta ble prompts questions about food; wh ether Miss Annie is able to get to the shops; whether the sisters are getting enough to eat. The member suggests Meals on Wheels can h elp.

The empty fire place should have

One of the most formidable tasks in the running of a successful division is the organlslng of a yearly training programme But it need not be, if it is tackled in a methodical way. One method , borrowed from industrial planning, is called a Gantt or loading chart. As divi ional training officer at Abingdon J have found this method very useful , running as many as six courses at one time.

The chart is simple to construct. Take a large sheet of paper, the bigger the better. J use six sheets of A4 squared paper taped together to form a rectangle 3 sheets by 2 sheets. Along the top (long side) insert the divisional parade nights, down the left side an activitie column, as in fig 1

The organiser now has a chart covering a whole year and all he has to do Chic) is to fill in the details The next stage is to extract from the interested parties, members and officers, what needs to be done in th way of activities and courses.

The more obvious ones will be :

First-aid an d nursing re-exams

Business eve nings such as the A.G.M.

Special courses such as air attendants, lay instructors, etc.

Interest lectures, mental health, drug addiction, etc.

Timing is very important of course, so don 't attempt a major course in the holiday season. Having entered the main activities in the lefL-hand co lumn , and decided on the timing of them, take some coloured pencils and colour in the evenings for each activity, one co lour representing each course. Thi not only

helps to easily identify each course, but also is guaranteed to impress any inspecting officer!

Having blocked in the main activities, there will be anu m ber of odd evenings vacant, which can be taken up with outdoor incidents and lectures

The details of each evening can be filled in on the main chart but I prefer a

separate sheet as shown in fig. 2.

As Robert Burns said 'The best laid plans of mice an' men so the occasional upset in plans must be expected. But let's hope it is rare J find a good contingency plan for emergencies is to have at least one spare lecture tucked up your sleeve.

The test demonstrated at Br gade F inals. M iss Ann ie was played by Miss H. E Gribble Assist Nursing Officer, London SW Area; the nursing member by Miss E George, No 9 Kensington D ivision

FIG

G. L. Richards

FIRST AID MAN

54-year-old Ambul a n ce Member Bert Lathwell of Vauxhall No 1 Ambul a n ce Division, Luton , was a wanted man ' by the British press a fter his h e roic actio n s during the Athens airport terrorist attack in August. (Se e AT RANDOM Sept.)

Mr. Lathwell was hot n e ws , and every newspaper wanted his st o ry . But a fter h e had returned t o England they just couldn't trace him, at least not for six days Bert apparently, had a r ea son for lying low.

For it seems his biggest ordeal was when he returned to Luton airport t o b e greeted by friends a nd rel atives. As th ey approached to offer congratulations Mr. Lathwell collapsed.

He said : ' } was dead scared tha t St. John Ambulance would think I was n ot fit to be a first-aider. Some one tr eat ing people for injuries should not get in a state and faint.

'But I suppos e I was inv o lv e d a bit myself. The first grenade went off only a few yards away 'I only did what I could. My t r a ining was very useful. First I looked round f or first aid kits, but there was nothing available. I treated one woman with a head injury I had to use her husb a nd 's shirt.

'Another woman had a badly injur e d arm and was losing a lot of blood I am not looking for any awards. I w ant ed to come back to England and be plain Mr. Lathwell, the first aid man. I wa s only doing my duty. I am glad the Brigade is pleased. I really thought they would giv e me the sack.'

KIDNEY FLIGHT

A Newcastle man, Mr. John Haswell , a volunteer pilot of the f,JA Air Wing , made an ex ceptionally fast delivery of a kidney for a transplant operation during August.

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST. JOHN

The in i ti al c all from t h e N a ti o nal Org a n Ma t c hing S er vi

London hospit a l a nd k nown t o b e available in New c astle was re ceived a t the Air Wing Co ntrol Ce ntr e, E p pin g at 7.40pm. Three q u art ers of a n h o ur late r , Mr. Ha swell acc omp a ni e d b y a secon d pil ot, D r. M ary S t o rri er of Po nt el and , Newcastl e a nd h e r husb a nd Mr. Mel Storri e r , als o a pilot , took o ff fro m Newcastle in a fas N avaj o ai rcra ft. T hey delive red the kidn ey a t Heathr o w , Lond o n at 9. 50pm o nly 130 m i nu tes after the initi al ca ll had b ee n r ecei ve d By 11.30pm t h e y we r e bac k i n N e wcast e. Dr. Mary Storri e r is th e co-o rd i n ato r of the New c as tl e group o f pil o t s of th e Air Wing.

The SJ A Air Wing h as now fl o wn mo r e than 4 ,000 miles on spe cial mission s sin ce it wa s formed 18 months ago. This flight was its 70th - 4 2 o f whic h hav e t a k en place during t h e la st s ix m o n ths.

PATIENT

The f ollowin g ette r a pp ea r e d in a r ecen t issue of the British Medi cal Journ al:

A pati ent o f m i n e wa s seve r e ly i nju r ed in a r oa d acci d

u a l proce dure is for t he local cons ul ate to a rr a n ge tra n s fe r by a co m mercia l air flight (fro m Fr a n ce th e cost migh t be up to £ 6 00 ). I a p proac h e d t h e Sl. J ohn A m bul a n ce Air Wing at St. Margaret's H ospi t al , Ep pin g, Essex ( t el ephone E pping 222 4 ) a nd the t ransfer was ' a rr a ng e d wit hin

BY THE EDITOR

Cadet to Mr. John Morley. ( P hoto: Ray Mantell)

winner for SJ A Somerse t. Held at Lady Brooke- Popham's home Bagborough House, near Taunton , th e day raised £ 1348 for S J J\ coun ty funds

The party also included Victorian tableaux, an exhihition of Vlctoriana an auction of Victorian antiques, and the' St. J ohn nursing cadet band from n ea rby St. Audries School des cribed by one party-goer as 'enchanting very small girls blowing larg e trumpet

CADET TO .

Following local government and St. John reorganisation from next April I , a new County of North Y orkshire is t o be formed. Being the large st cou nty in the country, it is to he divided into three St. John a rea s, Coastal, Ouse and Dales

To take c harge a Area Commissioner of the new Coastal area will be John D Morley , of" Scarborough, who Joined the Brigade as a cadet at the age of I I After qualifying as a schoolteacher he returned to Scarborough a :l Divisional Officer (Cadets), and also acted as Public Dutie s Officer for this busy seaside re ort.

In 1966 he took up his present appointment as County Staff Officer (Ambulance Cadets) for the North Riding I n this capacity he has pioneered leadership training courses in his county and has built up a close liaison between the cadet divisions He was made a Serving Brothe r of the Order two years ago.

Mr. Morley is deputy head of a large junior school in Scarborough and secretary of the local branch of the ational Union of Teachers.

ENGAGEMENT

The following poem is by Mrs Margaret Rolfe, of Teesside's Berwick Hills ursing Division :

Congratulations to our Princess Anne Now that she has met her man Greetings to the happy pair Hoping all the nations hare, I n making thi a wish co me true,

H ealth, wealth and happiness

Your long lives through.

Anne and Mark happy arc, Hunting, riding, near and far. J umping and showing their horses with pride, Now she' ll make a blushing bride.

Down the aisle she'll go, to meet her beau, A beautiful bride the nation 's pride, God bless them both As they pledge their troth.

NEW UNIT

Corps Transport Officer G Hardcastle of Yorkshire, writes:

I n September 1972, as secretary of the Barnsley and District SJ A, J launched an appeal to raise £1000 in 3 months, to buy and eq uip a mobile first aid unit. The idea was to purchase a 16ft caravan, and equip it with first aid emergency outfits, etc. By December 1972 the target had been reached and after discussions with Corps Supt. W . H. Parker we visited a caravan manufacturer and chose a Lynton Executive caravan.

This was modified so that a stretcher cou d be loaded into it. Our first prob lem was how we sho ul d tow the u nit. We had a litt le money left over and we were able to buy a secondhand ambulance our Area Commissioner being a great he l p in this move.

The ambulance was blue in colour and a Senior Citizen said he'd been only too pleased to paint it in St. John colours for us Next followed road tests, insurance , test certificate, etc, and finally a ll wa s ready.

On May 23 the unit was officially handed over to the Barnsley Corps on behalf of the Association . On June 14 it was officially welcomed and received in Barnsley , when the Mayor and Mayores s inspected it.

The unit is now fully operational and kept very busy.

I would like to express our apprecIation to all our friends in St. John for their help guidance, support and encouragement on the acquisition of this unit.

IN CHURCH

At this year's St. John's Day service for cadets at Herne Bay (Kent) Parish Church, a demonstration of artificial respiration was given by retired London Div. Supt. F C. Davey, who is now attached to the Herne Bay Combined Division.

LAST WORD ...

Ad-verbiage note: A New York loan company is advertising that 'We give m 0 n th to month resuscitation.' London Evening Standard.

'How do ! look in my see thro' blouse, Dan

A nursing member is often a young hOtlSelVife, slich as 25-year-old 1111'S, Jane Nichols, seen above leaning on rhe gale oj' her home in A venue, Chester-Ie-Street, Darlington, Co. Durham. Sh e probably looks composed, very contented - even as though she wouldn't say boo to a goose; as Jane does as she surveys the street. Bu! let som e thing untoward happen, .vh en the routine 0/ life may be in jeopardy

Last April a woman ran up 10 Mrs. Nichols to say a man's body was seen in the nearby Ril'er Ware. A /lOll-swimmer, Mrs. Nichols went straight into the river, pulled the rnan to the bank with the help oj a policeman, and started resuscitation. S oon the unconscious pensioller was breathing again

Mrs. Nichols, who has been awarded the R oyal Human e S ociety's resllscitation certificate, looks composed again, very contented a nursing member oj Chester-le-Street SJA Dil'ision.

Sabine, Barnsley)

The portable chamber can be used for transferring a casualty to a UK static chamber, or to bring a sick diver to the Guernsey centre. Here a transfer - under - pressure is to take place, with the portable chamber about to be locked on to the static unit

SJA Guernsey's

new recompression centre by R. J. HERVE, StaffOfficer(T)

An NCO at the controls of the static chamber, while a second operator looks at the casualty th rough the observation Window. The instrument immediately to the left of the 2nd operator's head is a physiological monitor, the leads of which terminate inside the chamber

These

TABLE 6B (OXYGEN)

Signul Station requesting that assistance be sent to a ship engaged on a diving project north of th e isbnd , where a diver was uspected of having contracted a severe attack of the bends.

The St. John inshore lifeboat was de patched ;.Ind soon reached the diving ship some 3 miles off-shore ;.Ind the sick man wa transferred.

First aid measures were immediately instigated and continued during the journey to shore. Here he wa met by u doctor and ambulance and with a police cscort was rushed to the ambulance

station, entering the static chamber shortly after 5 pm.

Treatment was promptly commenced but it was soo n realised that the man was in a serious condition, with loss of sensution in and inability to use the lower limbs. A treatment table was elected which demanded his stay in the chamber for ome 48 hours and it was in fact not until 6pm on the Saturday that the pressure in the chamber was lowered to 'surface' level and he wa released. While the sick diver was inside the chamber a continuous watch was maintained by two

operators. Attendants and the doctor gained access through the air lock at intervals to perform nursing duties and generally care for him.

After an overnight stay in the recovery room the patient was taken by ambulance to the local general hospital for further treatment.

At the time of writing it i hoped that the patient's recovery will be complete, but only further medical care and time will tell.

WITH ITS INST ALLA nON at the ambulance station now completed, Guernsey's static re-compression chamber is providing improved facilities for the treatment of the Bends.

For the past four years the Transport Dep artment has been in the possession of a portable one-man chamber, and with its ai d m any d ivers have received treatment for this unpleasant and exceedingly dangerous condition. Casualties suffering from comparatively minor bends were treated in the portable chamber while mor e serious cases had to be transported, in the chamber under pressure, to static chambers either in Cherbourg (Northern France) or the United Kingdom _

An article in the February 1971 R eview fully described the one-man chamber and its use in this holiday island.

However, experience gained by the use of the portable unit proved the need for a static chamber in Guernsey_Once inside the sma U chamber, a patient is inaccessible to the doctor or attendantsthus preventing medical treatment such as drip feeds or his physical examination by

12

the doctor. Also difficulties in quickly obtaining suitable aircraft to fly the portable chamber to a static chamber had been experienced on more than one occasion. So Area Commissioner R. H Blan chford, Offi cer-in-charge of the Transport Dep art ment d ecided after lengthy research and consultation with specialists in the field of recompression to obtain a static unit - and thus take an important step forward in the services undertaken by Guernsey St. John

With the financia l assistance of The Hayward Foundation of England, who provided the £13,000 requir ed for the complete project, an additional room was built at the station to house the chamber. Situated next to the compressor room (which provides the vast quantities of air required) and the r ecovery room, t he new recompression centre was formed.

The 5 ton steel chamber, manufactured by Siebe Gorman & Co. Ltd. has a maximum working pressure of 65psi. It has two compartments: the electrically heated treatment compartment, 7ft 6ins

long, and fitted with 2 bunks, a medical lock (enabling drugs, medicines, food, etc, to be passed into the chamber whil e it is under pressure), and an oxygen breathing system, which forms an essentia part of treatment ; and the air lock compartment, 3ft 6ins long , which can be decompressed separately, enabling an utlcndunt to ente r and leave the pressuris e d treatment compclrtmenl. Both compartments huve tw o- way telephone communication with the operators outside.

Already fully experienced in recompression work, the depurtment 's personnel were soon familiar with the new eLjuipmenL. Three cases werc s uccc ssfully treated by the team in qUick succession. One diver was suffenng from a neurologicul bend a se rious condition.

How ever, the prompt udmission to the cha m ber and subsequent trc;.Itment enabled the casuulty to be released after some eight hours under pressure.

A fourth case proved more dramatic.

Early one Thursday afternoon a telephone call was received from the Harb our

LITTLE OR NO instruction exists for members in the art (it is an art) of ambulance driving. This situation is being rectified by Ambulance Service Regional Training Schools, but at pre ent there eems to be a shortage of suitable instructors In the basic principles of vehicle control, one cannot bettcr the expertise of police driving schoo l instructors, who are indced giving much as istance to the Brigade and Ambulance Services How ever, the ambul;.lnce driver has considerations other than bu ic driving principle., namely his patIent and the patient's condit ion point often overlooked when instru ction i given.

Advanced driving

The Police Drivers' munual Roadcraft

Driving PART I

ESTABLISHED SJA INSTRUCTION by M.

(avuilable from mo I bookshops) explain effectively the principlc of advanced driving which enables the driver to proceed from point A to point B, quickly and safely, taking due consideration or all hazards which might illl pede progress _

Although written for car driver, this book is equally suitable for ambulance driver and hould be read by all drivers of Brigade vehicle

Advanced driving relies basically on the application of a sy tern or drill , the System of Car Control, each feature of which is considered in sequence at the approach to every hazard. By con'cct application of the Sy tern of Car Control, the vehicle should always be in the right place on the road, travelling at the right peed , in the right gear.

An e sential to advanced driving is ob ervation. The driver should always know what is going on about him, in front and behind. Better observation of the road ahead is obtained by keeping your di tance and careful positioning on bends (figs. I & Clues as to what might happen are constantly available and should be noted: eg children playing on the pavement, feet visible under a parked car, someone sitting in a stationary carthese are all indication of a possible sudden intrusion into the road by omeone; telephone poles or treet lamps may indicate the course of a country road ob cured by low hedgerow. Always anticipate th unexpected An emergency top in an ambulance may S:1Ve the dog in ( Col1{il1ued 011 next page) 13

AN ART FOR WHICH THERE IS LITTLE

V_ Moring

front and kill the patient in the back!

Many forces act on a vehicle under traction and these are most s table if the vehide is travelling in a straight line. For this reason it is best to keep the intended route as straight as prevailing tr affic conditions permit. Corners and bends should be taken at reduced speed to eliminate roll and/or skidding.

Skids : These can be a real danger to the ambulance driver. Most ambulances are built on commercial vehicle chassis and some of these adaptions are ap t to skid under conditions which the f a mily car would not. Also the extra weight involved the average ambulance weighing nearly two tons laden.

Skids are caused principally by excessive s peed for road surface conditions. They are further aggravated by harsh steering and acceleration or sudden or excessive braking To be able to correct a skid you must know what type of skid has occurred. There are three types: front-wheel, rear-wheel and fourwheel skids.

Natural reactions to skidding are panic and application of the brakes (if this is not the original cause of the skid). Do not apply the brakes. Reduce speed by releasing pressure from the accelerator. For front-wheel skids straighten the steering; rear-wheel skids turn front wheels into the skid, ie if the vehicle is sliding to the right turn the steering wheel to the right until the vehicle is stabi lised ; continue by steering the vehicle in the desired direction a nd proceed with gentle acceleration. Four-wheel skids are caused almost entirely by sudden or excessive braking. Eliminate this cause by ceasing to brake momentarily , then reapply brakes gradually, with slight initial pressure , increasing gradually.

To stop in an e mergency and avoid skids, the brakes can be 'pumped' quickly, alternating between being applied and released This gives a jerky ride but will effectively slow the vehicle without locking the wheels, which co uld result in a skid. Remember a dry road can be just as slippery as a wet one , especially where oil has been deposited such as at traffic lights or road junctions. A session on a skid pan ena bles valua ble experience to be gained in the correction of skids and is recommended

The Highway Code gives mu ch advice as well as statutory regulations with which all drivers must be familiar. Ambulance drivers s hould pay particular attention to new road sig ns, as they may not have time to ponder over their meaning when first seen.

Pra ctic al appl icat io n

The driver's temperament s all important and particularly so with ambulance driving It is said that a vehicle is an extension of the driver 's personality and any of his failings can be magnified to dangerous proportions.

Fig 1. Ambulance follows path A B' keeping in a straight line

An aggressive or angry person will drive aggressively. A tired person will often drive in a lazy, forgetful manner, as will the driv er who has taken his pro ble ms into the vehicle with him. The ambulance driv er must be both mentally and physically fit to carry out hi duties efficiently. H e must consi d er others (as should all first-aiders) and concentrate solely on driving. He must be comfortable in the ambu lanc e - bad positioning produces fatigue , and hence bad driving.

The ambulance driver is one of a team, with the attendant and so metime s a nurse or a doctor. He must act on instructions from the other team members wh en this affects the patient, ie a faster journey may be required (but usually the opposite is requested), or a longer route over better roads may be the order. The attendant is responsible for the patient in the ambulance - the driver assists by complying with the attendant's wishes with regard to the patient's condition.

On receipt of a call, if no instructions are given to the contra ry, the ambu lanc e driver must first d ecide if it is an emergency call. As a guideline in the absence of specific instructions from a superior, an emergency ca ll m ay be classed as any call for assistance where the ambulance might be the first trained assistance at the sce ne of an accident or s udden illness.

Calls which originate from do cto rs, nurses or first-aiders should indicate the urgency of the need fo r further assis-

VISUAL AIDS

The St John Ambu lanc e Multi-Media Appraisal Panel, which meets fortnightly at HQ and comprises doctors, nurses, first-aiders and visual aid experts, is one of the officially appointed panels of th e British Medical Association, its reviews being published in the BMA In fo rmation In J 972, the Guide to Films and First Aid was published (available from the Stores, 35p plus postage). [n mid-1974 it is hoped to publish with the kind assistance of the British Life Assurance Trust, a compreliensive multi-media guide to material on fir st aid, nursing and allied topics.

Fig. 2. Ambulan ce at position' A' can see dangers ahead, the shaded area only being blind to him At position 'B' all dangers would be obscured by van tance, but one knows that in such cases the patient is in the hands of someone trained in life preservation and although speed may still be essential, the urgency can be deemed to be reduced. II is essential therefore that anyone summoning an ambulance indicates any such circumstances that make its attendance urgent : ie, cardiac arrest, haemorrhag e, oxygen required, etc.

The R oad Traffic Acts allow speed regulations to be exceeded only by ambulance drivers , and then only when certain conditions exi t. The vehicle must have a blue flashing light operating, must be sounding audib le warning horns or siren, an d the journey must be urgent.

ComplYll1g with these requirements does not give the ambulance 'right of way' but merely indicate to other roadusers the urgency of the ambulance's journey. Jumping red traffic lights, etc, is illegal and could lead to a prosecution jf an accident occurred or a complaint is made. An ambulance driver must obey all road signs at all times (other than spee d restrictions, as stated) unless directed otherwise by a police officer in uniform , when exceptiona l care must be exercised to eliminate any possible accident.

All ca ll s for assistance should be attended as quickly as safety permits, but only on emergency calls shou ld speed limit s be exceeded and light s and horns put into operation.

(Continued next month)

LIVE AND LEARN: PART 1 - 6

Camera Talks Ltd 3] North Row London W] Slides (£5 each part) Filmstrips (£3.50) Tapes (£3)

Authors : Susan Ward and A. Ward Gardner

The ideas in these sets are probably the most junior versions ever produced ; it is believed that any teacher, playgroup leader or parent who really wants to teach safety and first aid can do so; children's drawings are used as illustrations in a lively and interested way.

P art I. Safety for Young Children (24 Frames) ; Part 2. Haz ard Spotting for Young Children (24 Frames) ; Part 3. Life Saving First Aid for Young Children (24 Frames); Part 4. Fire Pr evention for Young Children (30 Frames) ; Part 5. Accidents Don't Ju st Happen They are Caused (30 Frames) ; Part 6. Health Education for Young Children (33 Frames)_

The panel was unanimous that this series is an excellent visual aid that will be of importance in teaching young children safety and first aid.

The value of this teaching is manifestly in relation to the instruction given as a whole - it is not the pictures themselves that will tea c h but the following discussion The producers make the valid point that the best commentary will be that offered spontaneously by the young audience - class participation will be of great importance.

The simple idea of using children's drawings to illustrate the talks succeeds triumphantly it might even be desirable for the commentary to be spoken by a child.

The instruction given will depend on the age group of the chi ldr en but for the youngest the programme will have to be broken down into small packages.

In Part 3, it might be pr e ferable to adjust priorities and in Part 5, a slide summary would be useful.

The commentary is addressed to the teacher/parent rather than the child and does include one or two words not within a child's vocabulary.

Audience : F 'o r young children this is an excellent series; it will also be excellent for parent/child viewings; it is also a fact that parents and adu lt s will enjoy these programmes immensely and could well learn from them too.

LEARNING TO LIVE: 288

Camera Talks - 77 slides and 1 cassette: £7.50

This production shows hospitals for the mentally handicapped and how individual progress is retarded by environment.

This is an exce llent presentation that contrasts o ld -style asy lums with more modern hospitals for the mentally handicapped. Allhough the importance of staff initiative is shown the fundamental fact is that design, in this field, appears to have many shortcomings. ft is considere d that this field has been neglected in the past but unless the presentation is directed to the Keeper of the Privy Purse it is difficult to imagine to what use this presentation, excellent although it is, may be put.

Audience: Mental health committees, nurses in training, the general public as a 'talking point'

KEEPING WELL IN OLD AGE: 248

Camera Talks : Part 1: 26 slides, 1 cas ette : £7.50. Part 2: 3S slides, 1 cassette : £7.50.

This programme deals with health educa tion of the elderly within th e framework of the commu nity

The panel considered this an excellent presentation that gives a

From L ive and Learn - children's drawings to teach safety and first aid

clear picture of con diti ons in one London borough and methods adopted for the e ld erly to keep fit and retain joie de vivre. It will be of great value to the public at large but specifically to those approaching retirement and Over 60 Club organisers.

Audience: Of universal interest but of specific interest to those engaged within this field

SAFETY AND HEALTH AT WORK: 22

Camera Talks

Part 1: 34 slides plus cassette commentary: £7.50. Part 2: 46 slides plus cassette commentary: £7.50.

The panel considered this presentation to be excellent from the 0..sual aid view-point; the s]jdes are all clear, well-chosen and the commentary well spoken at a good pace. However there appears to be a lack of a central theme and the presentation appears kaleidoscopic including , as it does , too many facets of industrial safety.

The panel considers it undesirable practice to include 'how not to do it' in part] and 'The correct method' in part 2. onetheless, the panel considered this a good up-to-date presentation that will be useful for ab initio training.

Audience: Would be of value to all engaged in industry.

SOME INJURIES AND EMERGENCIES SEEN IN GENERAL PRACTI CE 24 slides, Price £2.88. Hire fee SOnp. Teaching Slide Set 48 ; the Medical Recording Service Foundation, Kitt Croft WrittIe , Chelmsford, Essex.

These photographs were taken by a GP in the course of everyday work. Most of them how minor injury; sometimes hin ts are given in respect of diagnosis or treatment but the slide are intende d for the first aid instructor to show to his class asking 'How would you handle this situation or this injury?'

The panel considered these slides to be of great value to instructors a a teaching aid; manifestly they cannot cover any specific field of first aid nor embrace the whole subject but they will have great value as a basis for discussion and learning. In the hand of a competent in tructor with appropriate sum ming-up the slides would make a welcome break from the more conventional ecture and a lso have value in competition and casualty make-up work.

Re commended as a useful visual aid at a competitive price.

Wound Infection

WHEN TO DI RECT A CASUAL TV

TO MEDICAL ATTENTION

THE SCANTY ALLUSIONS to wound infection in First Aid (3rd Ed.) and in The Essentials of First Aid and the complete absence of mention in New Advanced First Aid make one wonder if there is now any need to discuss the prevention of wound infection at a first aid leveL But the subject has not been ignored by all the textbooks : in New Safety and First Aid careful directions are given on how to cleanse wounds by the same authors who omitted them in New Advanced First Aid There are full discussions, too, in Nursing (3rd Ed.) , in Principles For First Aid For The Injured and in the Ameri can book Emergency Care. Furthermore, infected wounds and the occasional tragic death still occur in spite of first aid, early medical attention, speedy transference to hospital, asepsis, antisepsis, antibiotics, chemotherapy and immunisation. A brief discussion of the causes and treatment of wound infe ct ion is therefore justified to explain the techniques advised in textbooks.

Introductory b a cte ri o log y

To become infect ed wounds must be contaminated with bacteria, the microscopic organisms of various types that occur almost everywhere. Thos e concerned with wound infection are harmful in the extreme, but most bacteria are harmless and often useful. There are, for instance, soil organisms which break down vegetable matter into fertile loam. There are some concerne d with a variety of fermentation processes such as cheese production and m a ny others. Each has its place and the best habitat in which to flourish. The harmful organisms also have their favourite environment. The most common wound contaminants, the staphylococcus group, favour moist skin. Most of the staphylococci are harmless parasites, but some can give rise to wound infect ion , boils or carbuncles or even severe bloodstream infection.

It has been s hown that 30 % of the population carry these harmful strains in the nose and other p a rts of the body where moist skin is found. Other species, like the streptococci, at times extremely noxious , are frequently carried in the throat. The enteric group including colon bacilli , typhoid bacilli and dysentery bacilli are

by Dennis Clark , MBE, FRCS

carried in the bowels. Th e dr ea d tetanus bacillus is a soil organism. The rabies organism is found in the saliva of dogs suffering from the dis ease and in certain other biting ani mals.

These are but a few of the organisms which infect wounds. They can be introduced into wounds by inoculation, from bites , foreign bodi es or weapons; by dire ct contact with soil, dirt, fingers or dressings: from contaminated water and other fluids either in bulk or in the droplet form which occ urs in the breath of attendants or even floating in the air.

It must be assumed that all contacts with a wound may contaminate unless ca r efu l protective measures are taken.

Th e essential principles of the lo ca l treatment of wounds are imple; contro l haemorrhage and prevent infection. The old examination answer 'to keep blood in and to keep germs o ut puts the matter co lloquially an d is actually quoted in New Safety And First Aid. We are concerned with the second principle, prevention of infectio n , a difficult principle to apply. Nature's own prote ction is an impermeable skin. Onl y rarely do bacteria penetrate unbroken skin unl ess it i devitalised by injury or prolonged moisture. The rna in en try is through a wound, which presents an area of damaged tissue cells, blood clots and exudates.

At first th e bacteria are few in number but as c lot s and exudates become sta le the organisms multiply many thousand fold within a few hours. The body reacts to this increase by s upplying further exudates and legion s of mobile protective cells (the white blood corp uscl es) until a thick yellowish discharge 'pus' escapes from the wound surface. The wound is then said to be 'septic', 'suppuration' having occurred as the result of 'inflammation'. Inflammation is not mentioned in th e first aid m anua ls but is disc ussed in Nursing (3rd Ed.), in Principles For First Aid For Th e Injur e d and in Emergency Care. Th e first-aider should know the classical s ign s of inflammation (redness, s welling , h eat, pain and lo ss of function), for he may well be consulted when a wound goes se ptic and s hould know when to refer the patient promptly for medi ca l attention.

Methods of diminishing the risks of

post ca n be cleaned befor e and after use by methods that damp down dust rather than raise it. A clean water supply and cleaning mat er ia l ca n be arranged. Covered wa ste di sposa l ca n be provided. Clean lin e n and equipment sterilize d by boiling, by chemical methods or eve n pre-sterilized dressings and instruments can be obtained. If first-aiders do ho spita l duties, it might be possible to borrow a steam sterilized drum containing packs of swabs, dres s ings and forceps to us e in the way learn e d in ho spita l.

infection are outlined in mo t first aid books. Natural protection is supp emen t ed by c leansing and covering wounds with steri le dressings held firmly in place by bandage or p la ster. But wounds vary so much in evcrity and in the circumstJl1ces in which they occur that several methods of protection are needed both in the preparation for tr ea tment of wounds and in the technique. of handling them

Preparatory measures for wound treat m ent

On e of the most Jlnportant mea s ure s in prevention of wound infection is to ens ur e clean, light , dry surroundings. In h os pi ta lop erating theatres where wounds are made and closed purposely, the risk of infection is taken very seriously. Even before the theatre is built plun are made to minimise corners or crevices where dirt can collect, floors chosen which can be wa hed and mopped, uirconditioning supplied, and separate areas set aside to keep people entenng from contaminated regions away from the sterilized zones. In action, the theatre staff change Into sterile gowns, caps, masks, footwear and rubber gloves. At operation , presterilized fabrics are used for draping and towelling ti1e patient. Sterile and dispo uble instruments, fluid a nd dre ssings are used. A rigid di cipline is imposed on all in the theatre and includes a carefu l non-touch technique

In a casualty department, where contaminated casualties are brought from the street, such a st ri ct regime cannot be followed But planned accommodation and c lea ning arrangements can sti ll be achieved. Fabric, instrument and fluid sterilization ca n be e n su r ed. Attendants can gown, m ask, glove, cleanse carefu lly and fo llow a n on-touch technique. But the full discipline of separation of contaminated from terile zones is not possible.

In the first aid post there is not the continuity of conta mination that is a feature of th e co nstantly u e d casualty department , so there is not the need for the elaborate preparations required in hospital. Neverth eless, careful planning in the layout of eq uipment ca n be made to ensure a 'flo w through of cas ualti es. The

In the home or factory, where even fewer casualties are treated, the most desirable items are running water, good sanitation, enough a undry facilities to provide clean fa brics , equipment to boil or flame instruments, a first-aid kit containing pre-ster ilized dressings and a strict routine of caref ul handling. With ca reful attention to the dire ct ions contained in N ew Safety And First Aid several minor wounds and abrasions can be treated without need to refer them to hospital or docto r.

In the field or under primitive conditions the preparatory measures are limited to th e first aid kit. Wound tre atme n t is r ed uc e d to the essen tials stop bleeding and cover the wound That is why in most first aid books the directions are limited to minimal interference with the wound, immediate application of the most steri le dressing possible and the application of bandages.

T echn iqu es of w ound t r ea tm e nt

The first aid treatment of the wound itself, while founded on strict 'aseptic' techniques, differs in detail according to the size and type of the wound and the circumstances in which it occurred. Mention has already been mad e of the description in New Safety And First Aid for the treat men t of small wounds sustained in the home. It includes preliminary cleansing of the attendant's hands, cleaning the wound with soap and water , wiping first the skin round the wound from within outwards, then the wound itself, and c hanging the swab after every wipe. The wound is then co vered with clean or sterile dressings, padded with cotton wool a nd firmly fixed with strapping or bandages In some very superficial abrasions dressings are not needed and the best treatment is exposure to air to form dry scabs (nature's own dressing). Small cuts, it is suggested, can best be cleansed by washing under a running tap before drying and covering with a small prepared dressing In these cases no further treatment is needed, but in all others it is the first-aider's duty to obtain medical atte n tion.

The treatment of larger wounds when hospital facilities are not immediately available is discussed thoroughly in (Continued on next page)

CAMPERS ALL

London Distri ct's cadet camp, held at Totland I sle of Wight during August, was attended by 200 cadets and 81 adults - a very domestic week-u nder-can vas com pared with last year's jubilee camp, which included many overseas visitors. As usual the camp was at Stoats Farm, which is owned by Mrs Burt o n and family, who are honorary members of the Brigade

Chief Officer for Cadets , Col. Pat Adams visited the camp with District Supt. (N) Mrs D Hoadley who turns up everv year to see how the cadets are enjoying themselves

The ratio of cadets in camp was 3 nursing to 1 ambulance - so the boys got off lightly with domestic chores. Photographs by Frederick Jackson of Cowes

Wound Infection (cont).

Principles For First Aid For The Injured. After bleeding has received attention large foreign bodies or strips of clothing should be removed and gravel or grit wiped out with sterile swabs or picked out with sterile forceps. Fingers should only be used if a foreign body can be held without touching the wound Cleansing with medicaments is undesirable because of tissue damage from the medica tion itself, but tap-water or cooled boiled water is allowed. In primitive conditions without medical aid, careful cleansing is imperative and time must be taken to do it thoroughly. In most cases where a hospital can be reached within an hour or so, it is important to get the wound covered with a sterile or clean dressing of gauze or smooth cloth, padded with an absorbent material thick enough to prevent soaking through, and to support this cover firmly by a bandage exerting enough pressure to control bleeding or exudation. It must also prevent the movement of dressings, as this can introduce organisms into the wound from the adjacent skin by shifting or rubbing.

Certain dangers of wounds , apart from bleeding, mentioned in Principles For First Aid For The Injured, are worth rep ea t ing. A foreign body deeply embedded under the skin may be much larger than the wound of entry because skin is extremely elastic. For the same reason puncture wounds with small entries may have severe in ternal damage to blood-vessels, nerves, tendons and organs or may have introduced deep infection. The degree of infection from foreign bodies is relatively less from metals than from soil, road dust , vegetable matter, clothing or primitive dressings. F or this reason a warning is given against the use of a dressing made from an attendant's shirt, as this will carry the donor 's germs. Tyre rubs or roller wounds produce 'sleeve' injuries by pulling off the skin from underlying muscles and result in far more damage to the skin blood supply than would at first be obvious. At a later date this can result in the death of skin flaps even if apparently well stitched up. In all these cases it is the first-aider's duty to apply dressings padding and firm bandages and obtain medical assistance urgently

Dressings

All the available dressings are well described in the first aid books. Small prepacked sterilized dressings are us ually attached to a piece of adhesive. They are contained in a sealed plastic envelope and 18

have protective s he ets over th e dressing surface to facilitate application by a non-touch method Larger prepacked dressings used in hospitals are most often sterilized in autoclaves by steam under pressure and are vacuum dried. Commercially prepared sterile dressings of the larger sizes a re u ually attached t o a length of roller bandaging and should be items of first aid kits in the home, the field or at first aid posts. Improvi sed dressings made from any smooth fabric which is laundry clean are des cribe d in all first aid books and will do in emergency, but they must be backed by a l aye r of absorbent material thick eno ugh to soak up blood or exudates. If a dressing becomes soaked through, a further layer of backing should be added without disturbing the previous dressing. Dressings of all types must be kept in pla ce by firm bandages. A bandage has two main purposes, to keep a dressing, limb or splint in place and to apply pressure. Triangular and improvised bandages are first aid measures and cannot be expected to be efficient for long. First aid training in the application of dressings and bandages is too often inefficient. The reef-knot an d bandages for the various parts of the body are learnt conscientiously but insufficient attention is often paid to non-touch technique, adequate padding an d firmly applied band ages

Other methods of preventing wound infection

In Nur sing (3rd Ed.) New Advanced

First Aid and Prin cipl es For Fir t Aid For The lnjur e d allusion is made i mmunisation. The body ha s power Lo produce substa nces whi c h can destroy bacteria, the soca ll ed 'i mmun e bodies' or 'antibodies'. By a variety of methods so me of these ca n be artificially produced or the body ca n be stimulated Lo produce more of its own. Th e ub tance that interest firs t-aid ers are those thaL prevent tetanus and rabies. The administration is a medical responsibility because of certain ri ks tha t must be anticipated, but the first-aider shou ld know enoug h to guide a casualty to hospit a when a wound, however mall, has been con tamin ated from manured soil or been caused by an animal bite in a country where rabies is a danger.

Th e use of antibiotics and sulphbnamides o n wounds is also a medical rcspon ibility and not a first aid measure. In Prin ciples For First Aid For The Injur ed the resisLance developed by various bacteria to these substances is discussed and the opinion expressed that they may actua lly be dangerous by adding infection to a wound through their use.

This discussion has been aimed Lo take a little further the knowledge a lay instructor shou ld acquire on the subject of wound treatment. It amp lifi es the direction given in first aid textbooks but in n o way replaces them. It may aid the appreclation of different circumstances an d seventies that mod ify those directions. Above all, it is hoped, It will help the instrucLor to teach the first-aider when to direct a casually to medical attention.

READERS VIEWS

Readers' views and OpiniOnS, which should be sent to the Editor, although published are not necessarily endorsed by the Editor or the Order of St. John and its Foundations Although readers may sign published letters with a pen -name, writers must supply their name and address to the editor.

AMBULANCES

from J. L. Springer, Divisional Superintendent. In none of the letters or articles on am bulances in the Review have I seen any mention of the lack of Brigade policy on the subject, a lack which can lead to some peculiar difficulties.

For instance, I was told that Brigade ambulances going to and from public duties should not carry personnel other than driver and attendant. This is contrary to Brigade tradition and usage and I have seen nothing in Brigade Orders or other written form from Headquarters to this effect. Is it in fact so?

Again, this Division has run ambulances since 1964, supplying vehicles for events up to 40 miles from Denby Dale. Two Brigade units which used our services have purchased vehicles of their own . We lose £90 a year income.

Another Brigade unit near us was asked to cover a weekly stock car meeting. They decided an ambulance would be useful and bought one. Not only has this deprived us of a possible income of £ lOO a year (which would have made it possible to run our vehicles on a sound economic basis for the first time ever) but we must also, by Brigade ethics, offer them duties at hill climbs traditionally covered by our vehicles because the venue is in their divisional area.

Surely there should be some policy that existing ambulance capacity must be used so that divisions cannot face sudden losses of income like this?

We lose £ 120 a year actual income and an additional £ I 00 per year potential income because of this lack of policy.

I might add that we have very cordial relations with the Brigade units described.

Huddersfield

TheChief Staff Officer replies:

1. L. Springer

I have every sympathy with Mr. Springer in the quandary in which his division is placed. And yet all this has only come about because his neighbouring divisions have now been able to acquire ambulances and have thus raised their status to that of his division.

Wher ever there is the population to support a flourishing division there is usually plenty of scope for the use of an ambulance - apart from the active and perhaps somewhat attractive support of motor events. One knows of divisions which give regular assistance to old people, to the infirm, and which provide periodic outings for handicapped children.

It is very difficult to issue policy which in effect would inhibit the growth of newer divisions. Or, to put it another way, would it be right to make policy to protect the interests of the first in the field against the interests of newcomers?

Mr. Springer reports a loss of income of some £200 per year. From the Brigade point of view, might not the income, together with the stimulation that goes with the type of duty he describes, do more good now that it is shared by hitherto less fortunate units?

The question of the carriage of members is ra ther a delicate issue. If a vehicle is used solely for ambulance purposes the unit does not have to pay for an annual licence. However, when it is used to transport members it becomes something between a motor car and a bus, which is a totally different proposition, on which the views of Local Taxation and Police Authorities vary from county to county.

It would be a pity to jeopardise the concession concerning ambulances proper, but a letter to the local taxation officer should let you know how you stand.

There is of course a second aspect that must not be forgotten. When the public sees an ambulance on the road they naturally expect it to be able to carry out the functions of an ambulance. It would do the Brigade a lot of harm if one of our ambulances should come across an accident and be unable to take stretcher patients because its stretchers are stowed and seats fitted. Seconds count in sort of work and there is no time to spare for conversion.

BF1s

from D Lee, Divisional Officer

Every ovember or early December we secretaries of divisions have the task of filling in the B.F.I ., which I find very tedious especially as there are three copies to be filled in.

Now that the Brigade has become computerised, surely this task can be simplified - ie by way of making the forms like Form CRE/A (Class Record and Examiner's Report) as used in Association classes?

Three copies, each with carbon paper underneath, would save a lot of time and trouble. And if there is not enough space on one sheet, a continuation sheet could be used

This idea should save secretaries and HQ staff a lot of work Ravensthorpe, Yorks

D. Lee

BB

from Les Vincent

I really look forward to receiving the Review and was most interested in July Readers' Views . I would like to add my version for remembering the causes of shock:

BRIDGET - Bleeding ; BARDOT - Burns ; HAS - Heart ; ACUTE - Abdominal ; BODY - Body fluid loss ; BUT - Bacterial injury; EASILY - Emotional shock; CRUSHED - Crushed injury. Helston L. Vincent

'Don't bother to thank me, a couple of pounds of rump steak will easily get you out of my debt!'

from

Electricty Council's Ambulance Bulle tin

Concentration Ambulance Members N. Loader and C Simmons, of Dover assist Dr. Wood Robinson with a suspected fracture at a motor-cycle race. ( Photo : John Pitts, Seaford)

NEWS from SCOTLAND

The St. J ohn Village, Glenshee

The Priory of Scotland has acquired four acres of ground at Glenshee with a magnificent view of the valley and the river. We are now asking for building consent to the construction of a Highland centre. We hope to build welve chalet, a reception centre and living quarters for a warden. Each chalet will be heated and designed to accommodate 12 people in single rooms each with wash-basin, wardrobe, bunk-bed and chair; t her e will also be two showers, two lavatories and a drying room. The reception centre will be planned not only to give decent dining and recreational facilities but also a homely and welcoming atmosphere; it will be possible to partition the larger rooms to provide small temporary lecture rooms. The village, run by highly-trained warden, will be used as accommodation for mountain rescue training courses run by the

permanent training centre.

But the sil.e and position of the village ought to m ean that it can be kept fu ll y occupied throughout the year with other parties. It cou ld accom modat e young people who want to leave the cities for holidays in the hill and those whose local a uthoritie s encou rag e school-pupi ls to undertake field-work. It will be made ava ilable to St. John units outside Scotland who want facilities for training cade t s and at times it could be used as an international youth centrc. The reception centrc is to be built a a tribute to the lat e Mr. Boyd Anderson

Model of the proposed St. John Village, Glenshee and proceeds from the sale of properties given by him to the Order will meet its main canst uction costs. But money will have to be raised to finance the buildIl1g of the cha l ets, estimated to cost C.6,OOO each. A method of raising some money and providing for the permanen t use of the village is to encourage the formation of St. John units in firms. The eXistence of such a unit and the support given to It by management and emp loyees would entitle young men and women in the firm to use the chalets. An arrangement of this kind h:.Js already been m:.Jde with a business in cast Kilbride.

OVERSEAS

Flintshire

Organised recently by the Fli n tshire County Council's emergency planning officer at 1I 0lywell, an exercise to test call-out procedures and methods of setting up and equipping a rest centre in a peacetime emergency proved very successful. 150 people took pClrt.

It was assumed that a large civil aircraft had crashed on a denselypopulated part of Holywell and that more than 100 people, many injured, were homeless.

The homeless and injured were laken to the control centre in the old Grammar School premises and then to a first-aid post and rest centre set up in Carmel village hall, about two miles from Holywell. To give the exercise reality, the casualties were "made up' at the control ce n t re a nd arrived at Carmel in ambulances, buses, and other vehicles, where they received first aid (photo left and right) and refreshments.

Taking part were members of the County Council soci:.JI services dep:lftmenl, WR VS, St. ] ohn Ambulance Brigade and Gwynedd Constabulary.

K ENYA

The SJA Commander for Kenya, Sir Charles Markham, receiving his inSignia of K night of St. John from Pre sident Kenyatta at a recen 0 rder nvestitu re In Nairobi

St John's Day, in Salisbury. Sir Humphrey Gibbs, Kight Commander, took the sa lut e from local diVisions

(A) E J Ie Gallez , The Bailiff, Bailiwick Superintendent (N) Mrs. M. M Loveridge, Deputy Commissioner W. P Pryce, Commandant of the camp. In rear: D istrict Staff Officer (Cadets) (A) F. E Ford.

RHODESIA

MAURITIU S A SJA guard of honour at the wedding of Port Louis nursing member Chantal Vencatasamy, now Mrs. Lalljee

Winners - Laura Howe, Rosslyn Tregaskis, Gillian Walker and Shirley Diggle - from Clayhall Nursing Cadet Division who represented the Borough of Redbridge in a recent inter-borough first aid c"mf)etition.

News from Divisions ICentres

NORTHANTS-D iv/Supt. W. J. L. (Lew) Gotch, of Wellingborough, has 11 medals all of which he has earned, he says, as a St. John ambulanceman. His Serving Brother medal and long service medal do not require explaining. He joined the St. John Ambulance Sick Berth Reserve in 1922 and after 12 years received the R N .R. Long Service Medal from the Admiralty. He was called-up as a reservist in August 1939 and his 6Y2 years active service brought him the 1939-45 Star, Atlantic Star (convoy escort duties), Burma Star (Indian Ocean service), Italy Star (Mediterranean operations), Defence Medal (he was in Liverpool for the blitz period there) and the War Medal.

As a Brigade officer he was invited to become an officer of the Civil Defence Corps in the First Aid Section; for this duty he was awarded the Corps' Long Service Medal.

When the 1926 General Strike was imminent he was giving first-aid instruction at the local police station when the call went out for special constables; he was promptly roped in and after the qualifying period was presented with the Special Constabulary Medal.

He was recently awarded the 8th bar to his St. John medal for SS years Brigade service, and with the Naval Reserve Medal and bar (24 years), Civil Defence Medal (1 S years), Special Constable Medal (9 years) has awards for long service of

103 yearsl lI e' has <.llso been rewarded for long serv ice in the Royal British Legion, R .N. AssocIation and Oddfellows Friendly Society.

Hi s wife is a member of W e llingb orough Victoria Nursing Division; bel ween them they have been in St. J ohn for 90 years, a record with few equals.

NORTHUMBERLAND-M embers of St. J ohn in Germany were at a county Sf get-together at St. John House during August when the County CommiSSIOner, Mr. J Smith, presented a portable radio to retiring County Staff Officer (Cudets) Mr. H B. Watkins. Mr. Watkins, who joined Whitley Bay and Monkseaton Ambulance Division in 1941, county staff in 1959, is a Serving Brother.

OBITUARY

FREDl:RICK CLARK, 80, Corporal, SWlndon Ambulance DIvIsion. Joined DIvIsion in 19:26, retiring In 1960. Serving Brother. CLARA RFDMAN, Sergeant, SWIndon orth Division. Jollled indon lIrsing DIVISion in 1928, retiring in 1958. Servlllg Sister. Known in her district as 'The Angel'

MRS KATIlLl:E SMART, Nursing Member, 91 (Palmen Green) Nursing DiviSion. JOined this Dlvi,ion 111 1952, HSR member, secretary for last 3 years. Mayoress of Southgate 196:2-63.

MRS. AG l: WOOMES, DIVISional Superintendent, Stockton and Thornaby Nursing Division. Bn!(ade member for nearly 40 year' Serving S iste;.

SJA Workington' s stand at a local exhibition, with Georgine Briley on duty. The diSplay was organised by Divisional President Mr H. Horsley

BOOKS

REVIEW CROSSWORD No. 10 (73) Compiled by W. A. Potter

ACROSS:

l. A line from the south for this type of aperient (6). 4. There is nothing between nobleman and little sister producing a spi nal deformity. (8). 10. Do as directed and sit inside in overweight condition (7). 11. The amended rate for surgery. (7). 12. Shed the outer layer of the skin after sunburn. (4). 13 Requires repetition for thiamine deficiency dis ease. (4). 14 A degree thus is fundamental. (5). 16. 1 across having the same concentration as in body fluids. (6). 18. lllness from seaside di sor der. (7). 22. Worke r and a part of police force produce drug used in treatment of peptic ulcer. (7). 23. Muscular inc ordination from a conveyance with 30 down. (6). 26. Formed on the retina by the action of co rnea and lens. (5). 28. Sound reflection. (4). 29. A sud den paroxysm of pain in deep angina. (4).32. Le ss than a yard on which to stan d. (3.4). 33. Exhaustion arisi ng from bad ague fit. (7). 34. Used to control bleeding during surgery. (8). 35. Mari ne animal in the bath. (6).

DOWN:

1. Discontinuing a conservative dental treatment. (8). 2. Lord in Belgium (5). 3. Mea sure for epidermal appendage. (4). 5. After breaking toes , it is inflammation of bone. (8). 6. A lungful of ocean air? (4.6). 7. Old tax is back for places for building . (5). 8. Or ation for a cerebral cent re (6). 9. Tube for gastric aspiration. (5). 15. The overall care and treatment of the case. (10). 17. Exude a fluid. (3). 19 Number of muscles moving the eyeba ll. (3) 20. Surgical instrument in 15 down. (8). 21. De ath of tissue involving girl following gang. (8). 24. Phalan x at the end of finger or toe. (6). 25. Has fractured 12ins part of long bone. (5). 27. Mingl e d with c hopped mango. (5). 30. Groan weirdly in inert gas of atmosphere. (5). 3l. One of the flight. (4).

SOLUTION TO CROSSWORD No.9 (73)

ACROSS:

1. Tapeworm; 5. Co.sm.ic; 10 Broken hip ; ] l. Asset ; 12. A.rise ; 14 . Bark; 15. Cure; 16 Isolated case; 20. Involutional ; 22. Bu ck; 24. S.to.w; 25. Leper; 27. Tra.gi; 28. Ovulation ; 30. Suture ; 31. Ad enitis.

DOWN:

l. Tib ial; 2. Ptos.is; 3. Wee; 4. Rehabilitation; 6. Oral ; 7. Mu scu lar; 8. Catheter; 9. Operation wound ; 13 Eusol; 17. Dr.a.wl ; 18. Diabetes; 19. Evacuant; 2l. Splint ; 22. Trunks ; 26. Bier 29 Awn.

PRE-NURSING COURSE IN SCI ENCE

b y John M. Munroe. 3rd Edition, Churchill Livingstone. £1.

This is an excellent book, writt e n by the d ep uty rector and science teacher of a high schooL He d eals with the chemistry, physics and biology whi ch form th e basis of nurse ed u cat ion in a reliable a nd understand ab le way, which ca nno t help but benefit the student nurse. I would not recommend it in general to Brigade members , only to those abo ut to embark on a career in the nursing profession.

R.E.B

PLAY IN HOSPITAL

Edited by Susa n Harvey and Ann Hales- Duk e Faber . £ 1 40

This is a fascinating book which show how the trained play-specialist can help in the reh ab il itat ion of c hildr en in hospital. It is a book which would be of interest to any parent or Brigade m e mber as it gives an insight into the handling of c hildren. Som e of the case studie d are m ost enlightening and co uld form the basis of dis cussion groups.

R E B

PRINCIPLES OF NURSING

B y Nancy Rop er. 2nd Edition. Churchill Living sto n e. £1.5 0

A 1961 report, Peop le in Hospital stated 'much of the nur e's work today demands that she relinquishes her role as someone who do es everything for the patient and becomes someone who helps patients to look after themselves.'

This book is an attempt to help a nurse to do this. It begins by h e lping the patient to co mmuni cate, a chapter that would be of the utmost use to any St. John member. Then follow chapters on h elping to reh abilitate a patient, the su icidal patient and the dying patient. It then consi ders aspects of patient care, such as h elping the patient prevent pressure sores, with eating and drinking, respiration and so on; and finally , helping the patient to avoid hazards. It is a most interesting approach; stimulating, easy to read and remember. I would recommend it to anyon e interested in a wider knowledge of nursing procedures.

R.E.B

THE ESSENTIALS OF PAEDIATRICS FOR NURSES

b y I. Kessel. 4th edition

Churchill Livingstone, £2.S 0

This volume ca n be warmly recommended to all those interested in the care of sick children. The 4th edition has been brought up to date and new sections are a dded on burns, cot deaths etc.

Nurses in training a nd those thinking of a career in nursing will find this book invaluable

THOMSON'S CONCISE MEDICAL DICTIONARY

by William A R Thom son MD

Churchill Livingstone , £ I. SOp. Hard back

Dr. Thomson edited 'The Pr acti tioner ', a medi ca l journal renowned for its clarity of expression and s imple presentation. He has the art, all too rare these days , of making things understand ab e to the or dinary man

So it is with his di ctio nary This unpr ete ntiou s work gives a simple meaning for every word, with a s mall explanatory paragraph where necessary

First-aiders, especially thos e in industry , are often asked about medical terms a nd , indeed, in their o wn reading m ay co me upon new word s. This inexpensive diction ary will serve the m well. It would be a us eful addition to the library , not only for first-aiders but doctors and nur ses.

G. O. Hughe s

CLASSIFIED ADVERTISEMENTS

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Apply to Prrn c lpal NurSing Offi c er (8)

SOLICITORS ac ting o n b eh alf o th ei r Cli e n an educat ed w o man living

ST. JOHN AMBULANCE TOUR- MAY 1974

Express Boyd Ltd. are pleased to announce another tour next Spring to Syria & Cyprus. The itinerary is: -

DAMASCUS : MAY 11 th & 17th

PALMYRA: M ay 12th & 13th

ALEPPO: M ay 14th& 15th

LATAKI EH: May 16th

NICOSIA : M ay 18th to 24th

A f ull programme of tours has been arr anged in Syri a t o in c l u d e vis its to H oms, St. J ohn's Cast e in Aleppo, Kr ak des Chev aliers; and in Cyprus t o include Tr oo d os, Paphos and Li massol

£229.00 inclusive

For further inform a tion and bo o kings con t ac t :-

EXPR ESS BOYD LTD. Travel agents to St. John

(Formerly Express Travel & Transport Co . Ltd.)

4/5 Bonhill Street, London. EC2A 4BX. Telephone 01 -628 6060

When you're young, you want action right from the start of your nursing career. And that's just what we'll give you here at the Tunbridge Wells &. Leybourne Group of hospitals , You will learn about the latest advances in nursing techniques in our school of nursing and enjoy a lively social life in one of one of the loveliest corners of England. If you are over 18 and looking for action in a nursing career we can offer you a choice of fou r cou rses.

3 years for State Registration, or Registered Nurs e Mental Subnormality; or 2 year courses for State Enrolment, General or Mental Subnormality and Shortened Post Registration Courses.

Act now by writing, quoting ref. (J.A.B.l to Mrs. M. P. Crawford, Principal Nursing Officer, Education Centre, Pembury Hospital, Pembury, Tunbridge Wells, Kent. THE ACTION GROUP

QUICK CLIP

ADVANCED AMBULANCE AID KIT

Comprised of four elasticated bandages of varying widths and strengths for FAST, EFFECTIVE control of

HAEMORRHAGES FRACTURES DISLOCATIONS

SIMPLY WIND BANDAGE AROUND AND CLIP INTO POSITION THE ELASTICITY GIVES FIRM BUT GENTLE SUPPORT

APPLICATION OF THIS COLLAR PREVENTS THE CALCULATED RISK IN RESCUE WHEN MOVING AN UNCONSCIOUS CASUALTY FROM ANY VEHICLE AFTER ROAD TRAFFIC ACCIDENTS. APPLICATION OF THE COLLAR ALSO HELPS MAINTAIN AIRWAYS. IF NOT IN USE THE FOAM COLLAR CAN BE USED FOR PADDING ANY NATURAL HOLLOWS.

Recognising shock by R. A. Elson pA Visual Aids p 7

Around and About by the Editor p 8

At Random by Watkin W Williams p l0

Ambulance Driving by M. V. Moring p 12

Going Dutch by Ethel Lytham p.14

The County Sec p 15

The Lamb and Flag p 16

Readers' Views p 18

Order Investiture, Oct. 11 p.19

News from Scotland - Wales p 20

Overseas p 21

News from Divisions / Centres p.22

Edited and produced for the Order of St. John by DrIScoll Productions, 26 Pembroke Gardens, London , W8 6HU (01-6038512). Editor : Frank Driscoll.

New Commissioner-in-Chief

St. John Ambulance , 1 Grosvenor Crescent London SW1X 7EF.

With Britain's football season now in full swing, H eadquarters has launched a publicity campaign entitled 'St. John behind the TOUch-line '. I n this incident, Crystal Palace's boss MalCOlm

HRH The Duke of Gloucester. Grand Prior of the Order of St. John , h a s approved the appointment of Major General D. S. Gordon. CB , CBE, DSO. as Commissioner -in-Chief of St. John Ambulance Brigade; General Gordon became C-in-C on October I, 1973. In this capacity he is responsible for the organisation, admini tration. discipline and general training of the Brigade.

Prior to this appointment, Lieutenant-General Sir William Pike, KCB, CBE , DSO. occupied the dual role of Chief Commander and Commi joner-in-Chief with Ge n e ra I Gordon as one of his two Deputy Commissioner -in-Chief. Sir William Pike will continue a Chief Commander of the St. John Ambulance Foundation.

General Gordon, a native of Hampshire, wa educated at Haileybury and The Royal MiliLlfY College, Sandhurst. He has had a di tingui hed military career and was appointed Colonel of the Green Howard in 1965. During the war he served with hi regiment in Norway and later comm;mded a number of formation in Europe and the Middle Ea t.

For three years from 19 he commanded the 16th Independent Parachute Brigade Group and wa subsequently the General Officer commanding the 4th Division; the Chief Army Instructor at the Imperial Defence College; and a istant Chief of Defence Staff (G). Among hi many honours he i a Commander of the Dutch Order of Orange assuu.

General Gordon is a J u tice of the Peace and it on the Odiham Bench at Aldershot. His home at Greywell, near Ba ing toke, H3mpshire.

Wulf telling the conference about Germany's JU H

ol. Pat Adams,

Training,

anised the

nference

Fun and study at Nottingham

THE BRIGADE'S annual leadership course, held at Nottingham University, September 21 to 23, was opened by General D. S. Gordon, the new Commissioner-in-Chief, who stressed the vital need for good leadership in the Brigade.

The theme of this year's course was 'Human Relations', and the foundations for the weekend study were laid by Dr. Tudor J ones, Vice Principal, Caerleon College of Education, who was welcomed back to the conference for the second year in succession.

Overseas colleagues came from West Germany, Herr Wulfdietrich Peltz, (known as WUlf), Training Director of the Johanniter-Unfall-Hilfe, Herr Friederich von KaJckreuth, (known as Fritz), a Bereitschaftsfuhrer in JUH, and Major I. H. LeBlanc, (Hank), Provincial Staff Officer Training, from Quebec.

Wulf gave a most interesting account of the work of JUH in Germany and over eas, illustrated by an excellent film which was shown by Fritz.

The limelight of Sunday afternoon was an interesting talk on 'Darwin, the Man' by Professor Sir Hedley Atkins, Chairman of the Medical Board.

Other speakers included Dr. Ian Mackenzie, Deputy Commissioner for Derby, with some amusing anecdotes on 'The BedSIde Manner', and Robert Percival, Commissioner for Kent, who gave an interesting account of his work WIth St. John in Cyprus and igeria.

The usual dance was held in the Portland ballroom on Saturday evening, and judging by the delegates' expressions 'a good time was 'ad by all!

Air Wing's first rally

OVER 50 of the SJ A Air Wing's personnel, ll1cludlng 1:2 aircraft and 30 pilots, met at Buckll1ghamshire's Wy c ombe Air Park, Booker. on September 8 for the Wing's first full-scale pilots' meeting.

The WIng, which has mushroomed from 10 pilots and 4 aircraft to 108 pilots and 40 aircraft since its formation :2 years ago as a voluntary medical air service, has to date completed over 70 m iSSions throughout the British Isles and Europe

The Wing is becoming ltke a large club of light aIrcraft owners scattered throughout the country who offer theIr services free of charge for emergency medical transport : and the members usually only meet each other over the telephone, Invariably at night. when a mission is imminenl. lIenee there little time for ch;]!. The object of this first rally ;]t Booker wa to talk and get to know each other, and to get to know the capabilities of the members' different aircraft.

For such an organisation, which obviously has an ever expanding future but only a very limited past (in time), this rally should become an annual event for exchanging ideas and consolidating the service

Saturday evening again and more delegates' expressions

Among those present at the rally, which wa organised by the Wing's operations co-ordinator Pat Patterson were the COillmissloner-in-Chief General D. S. Gordon: Wg Cdr. Tom Fazan Chief Staff Officer: Mr. D. Orlik, Commissioner for Buckinghamshire lr. A. M. I. Paris the Wing's honorary surgeon: and Wg.Cdr. H. H. Drummond, the Wing's sel1Ior con troller.

Today's Air Wing aircraft flew into Booker from throughout Britain. (right) Planes of another generation - this is a World War 1 Morane fighter - put on a display at the rally

Two Elstree·based Wing pilots (nearest) Stephen Brod and Bill Bailey, who have both completed a number of missions

The Commissioner-in Chief Gen. D. S. Gordon (cent r e) inspecting Wing aircraft

Recognising Shock PART

ONE

PRIMARY

SHOCK , IF NO T CORR EC T ED , W ILL

LEAD TO THE MORE SERIOUS SE C O NDAR Y SHO C K

by R. A. Elson, MB, FRCS

exp lanation of Lhe factors regulating blood Dow to the various organs of the body. This knowledge must go a little further Lhan is usually expected for firstaiders but nevertheless it can be presented quite simply.

IN THIS SERIES of articles, I have attempted to provide the more enquiring first -aider with a fuller explanation of some of the emergency conditions with which he may have to cope. Some people might say that such information is unnecessary for the practice of good first ai d and to some extent I would have to agree; on the other hand, it is frequently the case that interest in a subject is stimulated by some deeper knowledge and I think this fact alone justifies attempts to explain things more fully. Clearly, in a structure so complex as the human body, it is only possible to present explanations approximately.

A diagram representing the tlood supply and distribution to the main groups of body tissues: the brain, the muscles, the kidneys, the skin, the gut and the heart muscle. The main distributing arteries are likened to an elastic bag or balloon which is kept distended by the pulses of blood being pumped into it by the heart. With each pulse, it distends and then smoothly expels the blood into the smaller arteries and thence to the tissues. The final supplying vessels to the tissues are the arterioles which can be likened to taps. These taps are closed when the sympathetic nervous system acts, the exceptions being the arterioles to the heart muscle which open when the sympathetic system increases its activity, and the brain supply which has no arte rioles and therefore is not directly affected.

The arterioles are tiny arteries containing muscle in their walls and contraction of this muscle closes them. They are represented thus : *.

T he sympathetic nervous system is dist ributed to the whole body by means of two long nerves (the sympathetic chain) which lie one on each side of the body on the back of the neck, chest wall,

and abdominal wall.

Especially in the following two accounts which will be concerned with shock, there are so many aspects of the subject remain unexplained that it would be fruitless to be too detailed The management of a patient in shock should be dictated by the rules laid down in the manual and no attempt should ever be made on the part of the first-aider, to attempt to diagnos e the particular type of shock with which a patient may be afflicted.

The two great rules to be followed in the management of a shocked patient are:

1. Protect the patient from further shock.

2 Transport the patient as quickly as possible to medical care.

Shock is usually divid ed into two ca tegories: primary and secon dary ; to these may be added nervous shock. There has been so me doubt as to whether one shoul d use the term secondary shock but it is a very real clinica l state, a very serious one. In general it may be sLated the nervous shock usually corrects it elf, that primary shock can be corrected by fluid or blood replacement fairly easily, but that secondary shock becomes increasingly resistant to any treatment.

In order to understand these conditions it is necessary to give some

R eferring to the diagram , the heart is represented as a pump driving blood through the lungs and whence , after oxygenation , it is pumped into a system of large arteries. These large arteries contain in their walls much elastic tissue and with every stroke of the heart the elastic is stretched. The elastic great arteries cou ld be likened to a balloon connected in some way to two tubes, one supplying pul es of blood from the heart and the other carrying the blood out for distribution to different parts of the body. The effect of Lhe balloon placed in this system would be to act as a reservoir of blood under pressure; the blood entering woul d be in pulses whereas tha t leaving would be in a moother continuous flow The whole mechanism of shock relates to the maintenance of pressure in the arteries.

If there were no elastic in the walls of the aorta and other great arteries, each pulse of blood ejected from the heart would produce a sudden rise of pressure which would quickly fall to zero between strokes. Because there is a balloon-like elastic system the heart pumps spurts of blood into this and out of the other end comes a steady stream of blood at a fairly constant pressure. True the pressure fluctuates with each stroke of the heart but it never falls to zero When you take a patien t's pulse, you are feeling the waves of pressure from the heart repeatedly distending the wall of the arteries; they never collapse completely , however.

The elastic system of great arteries, which has been likened to a balloon, provides a reservoir of blood under high pressure which can be distri bu ted through a series of tubes to the different tissues of the body In the diagram , five main types of tissue have been represented but there are of course many others. One tissue which must not be forgotten is the heart muscle itself and it will be seen that from the main distributing tube there is one group (the coronary arteries) which passes to the heart wall. The muscle of the heart is obviously one of the most important organs because without this the heart cannot create the necessary pressure for blood flow to occur.

Each of the tubes supplying individual types of tissue is provided with a mechanism for regulating the flow This can be likened to a tap , but in addition, the tissues themselves contain other built-in regulating mechanisms. For example, if the muscl es contract, as a result of becoming hard they squeeze blood out of the msel ves into the venous system thereby returning it to the heart; also waste products, due to breakdown of

glucose, accumulate in the muscles ca using the local arterioles (which constitute the 'tap' regulating blood flow to most tissues) to dilate, allowing more blood to flow into the capillaries, thereby bringing fresh glucose and oxygen to the muscle cells.

Slmilar devices operate in the gut during the digestion of a m eal, and to the kidneys although here there are many other complicate d regulating me chanisms which need not concern us. The brain has a very specia l type of circu lation which is regulated only by the demands of the brain cells themselves. The supply to the heart muscle is also special in another way, as will be seen later. The brain and heart muscle supplies are different because it is these two tissues which must be protected from loss of blood supply at all costs; if failure should occur , irrevocab le damage or death is inevitable.

To recapitulate, The heart pumps blood into an elastic reservoir of arteries from which branches lead to the tissues of the body conducting a fairly smooth blood flow. The amount of blood flowing to each type of tissue is controlled by 'taps' (the arterioles) which are regulated by local tissue demands and, as described next, by the nervous system. The heart and brain blood supplies have special regulating mechanisms which are necessary to give preference to these vital organs.

The nervous system controls all aspects of body function. It effects this control either by nerve fibres or through endocrine glands which will release chemical messengers (hormones) into the blood stream for distribution around the body The 'taps' regulating blood supply to the differ ent tissues of the body are controlled in most instances by the sympathetic nervous system. The latter is regulated initially in the brain stem and su bsequently its nerve trunks (the sympathetic chain) emerge from the thcracic spinal cord and are linked to a chain of nerves running down the whole length of the body which distribute further nerve fibres accompanying the ordinary nerves or in so me cases travelling alongside blood vessels. The supply is directed to the arteriole of the muscles, the gut, the skin and the Kidneys. In creased activity of the sympathetic nervous system, which always acts as a whole, results in the arterioles to these parts being contracte d and little blood can get through. There is no sympathetic supply to the brain arteries, so here the supply is only co ntrolled by the local demands (assu ming there is adequate blood pressure); the effect of sympathetic stimulation on the arterioles to the heart is to dilate these so that more blood is available. Thus, if the sympathetic system were to increase its activity, less blood would be supplied to the muscles , kidney,

Recognising Sho ck ( co n td .)

gu t and skin vessels and therefore because it would tend to remain in the great elastic arteries, the blood pressure here would rise.

Briefly, the sympathetic nervous system, always acting as one great unit , can correct a fall in blood pressure by increasing its general activity.

The sympathetic nervous system also controls two organs - the adrenal glands which lie just above the kidneys. These glands secrete adrenalin into the blood stream which is an example of one of the chemical messengers or hormones referred to earlier. Adrenalin circulates with the blood and in many ways has similar effects to the sympathetic nerv o us system; it can be thought to reinforce the effects of the nerves , but the nervous pathway acts more rapidly than the adrenalin and constitutes a more sensitive mechanism regulating the whole cardiovascular system.

T he sympathetic nervous system is always functioning at some level of activity directing a stea d y stream of n er ve i m pulses to control the arterioles (the t aps') which regulate the blood su pp ly to the tissues. If, for any reason, there is a shortage of blood as might occur after haemhorrage, the blood pressure would fall ; sensitive sensory organs would detect the fall and i m mediately, by means of nerve connections, increase the activity of the sy m pat h etic nervous system. The result wo uld be to close down many of the arterioles supplying the non-essential organs of the bo d y, thereby preserving bl oo d ; such blood as does pass through these arterioles would be quickly r et urned to the veins which also contract d ow n an d thereby return to the heart as q uickly as possible all available blood.

Th e elastic balloon (the great arteries) wo uld beco m e distended again and the bl ood pressure would be restored. The su ppl y to the brain would, on the other h a nd , be unaffected by the increased sympathetic nervous system and would only b en efit from the correction of the blood pressu re The supply to the heart muscle wou l d be actually increased as a result of th e sy m pathetic stimulation especially if t h e adrenal glands would also be secreting a dr enalin into the b lood stream.

Whenever an animal becomes angry or frig htenend, there is an increase in sy m pathetic nervous activity. This prepares the animal for the necessary physical activity involved in fighting, or running a way. Anger has the same effect. Students always remember fright, flight or fight as being the commonest causes of the increased sympathetic nervous activity.

It is always possib le to tell when there is increased sy mpathetic nervous system activity because in addition to controlling the arterioles to most organs of the body

6

there :ue some rather c urious side effects. For example, be ca us e the blood upply to the skin becomes reduced, it is pale and at the same time it pe rspires, es pe cially in certain area of the body such as th e face. Similarly , the littl e muscles that control the position of th e h ai rs contract und e r the influence of the sympathetic nervous system. Thi is the reason for th e hair rising wh e n an animal is afraid or in a state of shock; th e pupils dil a te and du e to restriction in the amount of blood going to the gut, the subject has a inking feeling in the a bdomen when sympathetic acti vity is increas e d. Finall y, there is a direct effect on the heart because, as well as i mproving the blood supply to the heart muscle there is always an in crease in the heart' rate. Th e s ubject becomes aware of his heart be ati ng and it is obvious to the examiner as an increase in· the pulse rate.

It was stated above that there is a lw ays some activity in the sympathetic nervous system and it is this which maintains the blood pressure constant. There are occasions, however, when the sympathetic nervous system becomes paralysed. An example of this m ay be when a subject sees an unpl easant or frightening sight; the thought or the sight of somebody having an injection is often enough to make even th e toughest man faint. The cause of this is that the shock to the nervous system result s in the whole sympathetic nervous system becoming temporarily paralysed so that instead of constricting the arterioles su p ply ing blood to most of the organs of the body, the reverse occurs, the taps open an d there is simply insufficient blood in the elastic reservoir to compensate for the enormous discharge into the great n umber of blood vessels sud d enly available for its escape. Th e elastic arteries collapse, the blood pressure falls to zero temporarily and there is insufficient pressure to maintain a circulation to the brain. The brain is at the uppermo st part of the body and in such a situation must suffer most. Unconsciousnes s rapidly supervenes as a result of which the subject is spared the thought of the injectlOn or the unpleasant sight; he usually falls to a horizontal position, th e value of which is to allow blood to r each the brain again; in this is the value of lying somebody flat who feels faint, or putting his head low between his legs

Usually, the sympathetic nervous syste m quickly recovers thereby restoring the blood pressure.

Another type of fainting is see n in the soldier on parade but is due to a somewhat different cause. The so ldier at attention is not using the muscles of his body and as a result the blood whi ch is constantly flowing into these tends to collect and is not returned to the veins. Normally, whenever a muscle co ntra c t s it squeezes blood from inside itself out into the veins and thereby aiding its return to

the heart. If the muscles are n ot repeatedly co ntra ct ing this mu cle pump system, as it is so metimes ca lled, whereby blood i returned to (he vei ns is not f unctioning ; the heart is not receiving as mu c h blood as it should and wh at it does not receive it ce rt ai nly ca nnot pump ou into the e la stic reservo ir. Th e latt er gradually bec o me d e pr ive d of blood and ther efore the blood pressure mu st fall, ca using fainting until the soldier li es horizontal o n the ground.

It will be seen from the a b ove explanation that the bl oo d pressure must be maintained if the brain is going to retain a cir c ulation and if the heart muscle is going to remain nourished Anything which allows the blood pressure to fall will result in un conscio u s ness and it is the function of the sympathetic nervous system to e nsure that not too much blood is l ost from the elastic reservoir at one ti me; such a sta te must lower the blood pressure.

If there is insufficient blood returning to the heart a l eak of blood from the arteri es as might occur in a haemhorrage from a cut vessel , or if two many a rterioles are ope ned up as a result of sympathetic paralysis the blood pressure will fall. Wh e n eve r the blood pressure falls the det ecto rs which lie in the great arteries of the neck a lw ays respond by sending urgent me sages to the brain stem an d thence to the controlling centres of the sympathetic nervous system; the latt er increases its activity shutting down the arterioles to the less important organs; muscle, kidneys, gut and kin. The brain is spared because th ere is no sy mpath etic nerve supply to its vessels, and because the effect of the sympathetic nervous system on the heart mu scle is to actually dilate the arterioles, thereby increasing the blood supply to the heart muscle , the heart is enabled to function more effectively at the expense of many other organs.

It will be seen that a low blood pressure can be produced either because there is insu fficient blood (as in a haemhorrage) or should the tot a l volume of all the blood vessels available be increased (as would occur if there were sympathetic nervous syste m paralysis and all the arterioles supplying the less important organs dilated allowing blood to escape into these)

Always , the sy mp at heti c nervoUS sys tem reacts to co mbat the fall in blood pressure what e ver the cause and th e signs of in c rea sed sympathetic activity (pallor, sweating, dilated pupils and rapid pulse, perhaps a rise in temper at ur e and , contrary to common tea ching , a rise In blood pressure) tell the first-aider that the pa tie nt is in a state of shock. Thi s is more correctly primary shock. Next month we will attempt to ex pl ai n how primary shock if not co rrected will lead to the far m'o re serious situation of secon dary shock.

VISUAL AIDS

BRITISH TR A N SPOR T FILMSTR IPS

The St. John A mblllance Multi-Media Appraisal Pall el which meets fortnightly at HQ and comprises doctors, nurses, first-aiders alld visu al aid experts, is one of the officially appointed pallels of th e British Medical ASSOCiation. it s reviews being published ill the BMA 'Information '. il/ 972. tile Guide to Film s and First Aid was published (available from the Store s, 35p plus postage). in mid-1974 il is hoped to publish , with the kind assistance of the British Life A SSll ral1 Ce Trust, a comprehensive multi-media guide to material all first aid. nursing and allied topics

British 1 ran s port Films has recently reviewed its excellent series of first aid filmstrips so that thcy may be brought into li n e with the 3rd e d ition 0 r the J oin t Man ua!. Nine of the series have been revise d. Also it is now their intention to supply these sets as slid es in 2i n. by 2in. formJt.

Many members have acquired these excellent Visual aids a t mJl1imal cost and those member s not in possession of this series are 'Ilrongly advised to obtain them from British Transport Films, MeJbury Terrace, Lond o n , NWL. 6LP.

BT. 110 7 bnergcncy Resus c it a tion 68 frames. B & W.

BT. 1108 Fractu res Part 1 53 Frame s. B & W.

BT. 1109 I·ractures Part 2 69 Frames. B & W_ 13T. 1110 and Band ages 72 frames. 13 & W. 13T. 1111 lI and lln g & Transport of Injured Per ons 84 hames. B& W. 13T. 1112 Applied J irst Aid 41 I"ra mes. Col. 1.3T. 1113 Burns, POisons and Mis ce llaneous Condition 61 Frames. B& W.

BT. ll14 ,\ ounds, Bleeding and Cuculatory Failure Par t 1 62 Frames. Col.

BT 1115 Bleeding and Circulatory Failure Part 2 47 Frames Col.

BT. lOIO First Aid Competitions 61 Frames Col.

Pn ces, plus V A.T .: B & W. stnps £1.50, slides £2 75 Colour strip £2.25 , slides £3.50.

EXAM I NI NG A CAS UA LTV ON AI NS

The Medical Recording Service Foundation Kitts Croft Writtle Chelmsford, Essex_ Tape Slide Programme, SO Price £9 Hirefee£1.

Thi s programme s h ows examination and diagn osis in m oun tain eering or hill-climbing expeditions.

The panel considered that thi presentation needs revision. The programme fails to stress the priorities of examination for breathing and bleeding before examination for other injuries; it also employs a plethora of technical terms beyond the scope of the average first-aider. From the visual aid view-point th i is not an adequate tape/slide presentation but an illustrate d lectu re which is over- long and so mcwh:l t ponderous_ However, th e panel recognised that the presentation is dir ected towards mountain rescue sit uati ons; it consi d ered that the presentatIOn does present comprehensive examination and di agnosi in difficult circumstances and the method of eX:.Jminution portrayed presents u efu teaching To that specia li ed audience with an introduction upon priorities and a comprehcn ive s umming-up , the programme will have value.

THE YO U T H DR U G SCE NE ( 1969 ) (Co l: 30m n s.) Hire.

Distributed by : Concordia Film Library - Nacton, Ipswich, Suffolk_ Produced by : Family Films, U.S.A.

Thi s film purports to portray a true story of a teenage drug

The boy himself and his family tell of his drug taking expenences. As the 'hero' was an addict for thre e years and has now stopped using drugs of addiction, the film i pre ented from wi thin experie nee.

Th e panel considered this an over-long film that fail to present its message with any impact. It lacks co ntinuity and its use of the real family in the particular situation as performers in tl:e film fails to add realism; for this country, the Amer ica n dIalogue and glossy standard of living lends, unfortunately, an air of unreality to the film.

Not r ecommen d ed for exhibition to St. J ohn audie n ce.

HELP IS ( 1972 ) (Col: 1 6 mins.)

Pro d uce d by: National F ilm Boar d of Cana d a_

Distribution: R ank Film Li b rary. P O Box 7 0 , G t. West Rd ., Brentford , Meddx., TW8 9HR Hire:

Th is film illustrates the necessity for the man in the street to be aware of the principles of first aid with specific re fe rence to motor vehicle acci dent situations.

The 1 ational Film Bo ard of Canada indicates a high standard of production - this film certainly has that - it is of good length, colourf ul of great clarity and punches its m essa ge home; it suceeds admirably in showing the necessity for first aid instruction for all. It is a pity, howev er, that our experts do not consider first aid portrayed in the film as faultless. The unconscious patient should be placed in the re covery position , a sterile dressing is placed on top of a ring pad and the film does not portray adequate examination or diagnosis. The use of the spinal board might have been amplified also.

But within the concept of the film these are critiCIsms of detail; the overall umpression is one of excellence.

Audience: Universal. Of great value to St. John

REHABILITATION OF THE LONG -STAY MENTAL PATIENT ( 1960) (Co l: 25 m ins.) F ee

Distributed by : British Medical A sociation. Tavistock Square, London W C.I. Produced by: Joseph R owntree Village Trust. This film shows how deteriorated schizophrenics who have been 14 years in ho pital can have a full and varied day of activities without undue expenditure of money. It is directed toward nurses and shows how their interest and enthu iasm can be stimulated.

The panel considered this an excellent film that portrays its subject both with dignity and humility. Although 11 years old the co ntent is still up-to-date and, possibly, its mental health concept is still in advance of other establishments.

Audience: Of great value to a ll concerned with mental health and could be creene d to all St. John members_

7

R ight) B R's Group Medical Officer Dr. Claud Newman, presented a set of the British Transport film strips reviewed here) to the Chief Commander S William Pike. for use at HQ

TOGETHER

Exmouth SJA station has paid and voluntary members, but all the paid staff are voluntary members of the local division. Here's an example of how they work together.

On a recent Saturday evening A / M M. Kavanaugh , a paid member , received a call to a cliff acci dent near a local holiday camp, Sandy Bay. With a cre w comprising A / M S Spratt , C/ L ea der S Ide and Cadet D. Gossington and equipmen r (ropes, Niel Robertson Stretcher, etc), he went to the scene, collecting another paid member Cadet Supt. G. Coates en route.

From the cliff-top they saw a girl17 -year-old Susan Aldridge - lying injured about 150ft. down the cliff. The three-man team go t down to her and diagnosed a compound fracture and dislocation of the ank le, with severe haemorrhag e, the foot appearing to be half severed; a nd there were two further fractures to the fibu la

A /M Spratt and Cadet Id e went back to the cliff-top and returned with A / M Kavanaugh a policeman and the equipment. Supt. Coates had by then straightened the leg an d bandaged the wound; and with Cadet Gossington, police and coast-guard at the cliff-top the casualty was brought up on the stretcher.

Recent rain, heavy sea-mi st and dusk made it a hazardous 20-minute climb; with a police escort the patient was taken to hospital at Exeter.

A I M Spratt , a voluntary member, was about to go out with his girl-friend when the call ca me; instead he spent part of the evening on the cliff-face in his best suit!

I only hope his girl-friend understood.

AROUND and ABOUT

WHAT'S GOING ON IN THE WORLD OF ST. JOHN

BY THE EDITOR

ANTI-CHOLERA

To help stem the spread of dise ase following the recent catastrophic floods in Pakistan, SJ A has given 24,000 doses of anti-cholera vaccine to the stricken areas.

The consignment of vaccine h as been flown to Kara chi by Pakistan In tern ational A irlines and will be distributed by The Pakistan Red Cross.

DISABLED BUT

The Association 's highest honour - life membership - has been awarded to London phone technician Mr. Ernie Chapman, of Forest Gate who has himself been almost crippled since the war.

More than 90 per ce nt disabled , Mr. Chapman has won every first aid award since his first lesson 14 years ago.

Today he ca n deal with any situation, from a broken finger to a premature

APPOINTMENTS

Oxford: J E. H . Collins, MBE

DSC to be Chairman St. John Council.

Zambia: Mr. Radford resigned as Deputy Commissioner on moving to Australia.

birth. Two years ago he saved a gul' s life with heart massage.

He took up first aid when he realised the number of lives which could be saved with basic medical knowledge, he ays in Courier, the PO paper.

People don't realise how easy it is to save a life if they go about it the right way.'

'But if they don't know any first aid they make the situation even worse'.

UNUSUAL

BUT . Sid mouth member Bill Palmer prevented

an unusual but obviously possible fatal accident recently

Mr Palmer noticed a frozen food van parked at the rear entrance of a food shop with its indicator lights flashing. Seeing no-one near the van, he went over and heard muffled cries coming from Inside the van. He climbed into the cab and shouted: Are you all right?'

The delivery man was trapped in the van's refrigerated compartment after the door had c losed behind him. He houted IJ1structions on how to open the door , and but for Mr. Palmer's prompt action the man could have been frozen to death.

SICK

Four 17-year-oJd ambulance members who are all ex-cadets, of Selby, Yorkshire, were at a Brigade-organised disco' on Sertember 20 when a call was received that a bomb had been planted in a local old peoples' home. The police decided on a mass evacuation of the home . The local Brigade-run ambulance service turned out ix ambulance, calling in other from Goole and Castleford.

The young ambulance members (see

BOMB HOAX

The four 17 year old ex cadets from Selby who were involved in a bomb hoax. See SICK

READY TO START

photo), Stephen Gill, Trevor Ramsay, Stephen Burke and Ian Boynton, travelled in one ambulance to the home and helped out the 79 elderly people, many of them unable to walk so that the police could search the premis'es

The ambulances and a bus, in which our mem bers travelled to York looking after tho e who could walk took the elderly people to temporary homes and hospitals.

The call came at 8.20pm, our members returned home at 2am that night, later to receive letters of thanks from West Riding authorities.

The call was a hoax - no bomb was found. Very funny. Very sick. [ trust the hoaxer himself/ herself won't one day live in an old peoples' home.

RETIRED

I hear that the Commissioner for Surrey, Mr. Barry Robinson, BEM JP, CStJ, retired on September 30 after 45 years' with St. John Ambulance.

Originally from Reigate Division, Mr. Robinson transferred to Horley Division as transport officer in 1933 became area commissioner (E) in 1951, deputy commissioner (Surrey) in 1966, and commissioner in 1970.

His successor is Dr. A. R . H. Hicks, a SJ for 24 years and deputy commissioner since 1970. Dr. Hicks joined as div. surgeon at Harrow in 1951 then transferred to Horley Division and became area surgeon in 1965. During the last war he served with the RAMC in France and India.

Before the work starts at a leadership training course, during September, when Cheshire members were joined by those from Staffs La nes Cumberland and Westmoreland Col. Adams: Chief Officer Brigade Training, is on right of photo

A double dedic ation - of headquarter's and an ambulanceat W iltshire's Westbury Combined D ivision recently M arvel lou s. ( Photo Wiltshire Times)

Marines and th e Dorset and Bourn emo uth Constabulary. The Superint ende nt of Bridport Ambulance and Nursing Division told th e meeting of his Division's experience of using a ma i n radio with three personal sets which had been presented to th e m Th ere was a static display of co mmuni cations equipment by the Marines Poli ce, Bridport St. John and Pye R a dio.

The day fully achieved its purpose of m aking the various St. John divi sion think objectively of how they might obtain and opera t e suitab le equipment to increase their ow n efficiency and so improve the service that they can give to the community.

DOUBLE

COMMUNICATIONS

Every other year SJ A Dors et holds a training day to study some aspect of their activities. These have included rescue fro m cliffs and beaches, of trapped casualties from vehicles and hazards affecting first aid situations. This year, with over 150 Brigade members present, the subject was 'Communications'. The training day took place at Th e Royal Marine Establishment, Poole.

The day was divided into two parts. In the morning the R oyal Marines laid on two demonstrations. The first consisted of a sea disaster in which a yacht was presumed to be on fire but able to make port. Just before docking there was an explosion, followed by a fire, and as a result there were six casualties (provided and made up by Casualties Union) suffering from various burns, fracture s and asphyxia. The yacht did not have ship-to-shore radio and so the first notific ation received by the emergency services was a telephone call from a memb er of the crew after docking When the ambulance and fire brigade arrived the fire had a good hold and two of the casualties had died.

The second d e m onstration repeated the situation of the first one but this time there were full communication facilities

The spectators heard, over the loudsp eakers, messages passed from the yacht to a coastguard station which then alerted the emergency services. Ambulanc es and the fire brigade were dispatched As a result these were

waiting at the dockside when the yacht berthed and able to take i mm ediate action 'to deal with the fire and the cas ualti es. The two asphyxiated patients survived and the con diti on of the others was greatly improved due to the ear li er treatment.

Between the two demonstrations spectators were able to view the make-up and treatment of the first batch of casualt ie s.

After lunch there were talks from communications experts of the Roy al

NEW

Messrs Guild Sound & Vision (film libraries) are moving from Merton Park to 85 129 Oundl e Ro ad, Peterborough, P E 2 9B Y Key dates for library operations from this new address are: Nov 5 1973, Tr aining and Education Film Library; D ec 3 1973, Sponsored Film De spatch; and Jan 4 1974, Sponsored Film Bookings

YOU ARE THE THINK -TANK

Welfare Cup competition

We want your ideas, in an essay, on the best way to award a Welfare Cup on a national basis:

L Entries (max. 2000 words) to be divided into two categor ies: a) Aged 16 years or over on bebruary 1 1974.

b) Under 16 years on J anua ry 31 1974

2. Essays to be typed or written legibly (one side of paper only), and sent to: Th e Chief Nursing Offi cer SL John Ambulance Brigade, 1, Grosvenor Crescent, London, SWIX 7EF by January 31 1974.

3. Entries to have the word 'We lfare' written on the top left-hand co rner of

AT RAN DOM

the envelope, and must be accompanied by the writer's name (Mr, Mrs or lI!iss) Brigade rank and unit (Division, Corps, Area, etc.) or other connection (eg Pr esident, Auxiliary).

4 Entries in category (b) to give the wTlter's date of birth. Those which do not give thiS information will be treated as catego ry (a)

5. In judging the essays, credit will be given to ideas on the subject, and only 111 the event of a ti c will the quality of th e essay itself be taken into account.

6. There will be a prize of .£5 for the best essay in each category.

A second prize may be awarded in either or both catego ri es if the stand ard of en tries warran t s L

round the country a gr eat deal since he joined us at headquarter s 18 months ago; but I reckon that I can claim to know him better than mo s t, for, having shared an office with him throughout that period I have greatly a dmir ed the immense care that he has taken to stu dy the work of th e Brigad e in a ll its aspects, the wise judgment that h e has shown in helping to solve many problems, and the infectious enthusiasm with whi c h he has approached a task that by no means his first exe r cise in good le adership And I hope you do not need to be assured that one of the very first things he did after joining headquarters was to take a first aid co urse and qualify as a first-aider! It is sad to say goodbye to Sir William Pik e in his capacity as Commissioner-in-Chief, a post that he has filled with quite outstanding success for just over six years; but it's good to know that we still have him as o ur Chief Commander, an d I mo t sincerel y believe that hi wise and ski l ful choice of a successor will prove to have set the sea l on his contribution to the life of the Brig ade, for the real test of leadership is not what happen while the leader is in office but what goes 011 happening when he has handed over to someone else.

Last Day

Another reason for my special desire to be at headquarters on October 5 was that this was, alas, Miss Ann CoHhurst's last day as Warden of St. John Hous e Club, and though the catering for the Secretaries' Conference that day made it one of the busiest she ever had and a quite impo ible occasion for the farewell party that we shou ld have lik.ed to have given her, I wanted to say a personal goodbye' and 'thank-you'. In her years as Warden Ann has steered the club through many difficult periods and has made many friends who will deeply regret her reluctant decision to make a move. She has promised to give u a chance of bIdding her farewell on a more su it ab le occasion in the near future; meanwhile she can be assured of the deep gratitude and good wishes of all who have known her at the club. I am glad to say that her former deputy Mrs Wil son, has kindly agreed to succeed her as Warden, and th at Mi ss Garbett has accepted appointment as Deputy Ward e n , and I am s ure that in their good hand the c lub will continue to flouri sh.

Tell me

by Watkin W. Williams, Deputy Commissioner-in -Chief

EYEBROWS LIFTED in surprise when, laden with lugg age , I walked into Grosvenor Crescent at 9.15am on Friday October 5, having been inspecting Brigade members on duty at first aid posts at the 10

Nairobi Show the previous afternoon. I didn 't start doing any office work that day, but 1 was at least able to report 'mission accomplished' and to greet a number of colleagues, and especially

Major-General Des mond Gordon, our new Commissioner-in-Chief.

General Gordon is already well known to many Br iga de members throughout England and Wal es, for he has travelled

he turn ed to me and sai d : 'Now [ want you to tell m e all about SL John Ambulance, because I believe it is so m eth ing that it would be a great benefit to us to adopt officially in Kw a Zulu .' Wh en he further told me that his enquiry constituted an official request, I made it c ear that since Kw a Zulu came geographically under the administration of the Priory for South Africa, from which I was sure he would receive all possible help an d s upport , it would be my proper duty t o convey his enquiry to Priory H eadquarters in Johanne s burg; and to this he entire y agreed.

Following our discussion and while [ was staying some ten days later in Pi etermaritzburg, I received a request to ca ll on Me Dladla, the KwaZulu Councillor for Community Development, who confirmed his government's interest in SL John Ambulance and his desire to be put in touch with Pri ory H eadquarters.

Having during the interval met as least six doctors working at Mission hospitals and elsewhere in KwaZulu, all of whom were very enthusiastic about the idea and promised their most active help and support, and having also been asked to give a talk on the work of S t. J ohn Am bulance to a splendid audience of about fifty trainee Zulu nurses at the Charles J ohnson Memorial H ospital at qutu, I was shortly afterwards able to report all this to the Prior for South Africa and the Chief Commissioner of the Brigade when they kindly entertained me to lunch and showed me over the Pr iory in Johannesburg.

They received the news with great enthusiasm and promised to give all pos ible help in the initail stages of settmg lip St. John Ambul a nce in KwaZulu and enabling it to develop the fullest degree of autonomy within the Jurisdiction of the Pri ory. So I'm hoping that my chance meeting at ongoma may have set up a fre h mile tone in the history of St. J ohn!

Meeting

I left qutu one morning at 5am to be driven 40 miles to Glencoe to catch a train to Pi etermaritzburg a ISO-mile journey which took just over 6 Y2 hour with stops at every station!

divisions had assembled to meet me, and for nearly two hours we had a very lively and stimu lating discussion which will long remain in my memory.

The following day, which was unfortunately cold and drizzly (I believe they had snow the day after), Mr. Strydom ( Distri ct Staff Offi cer) kindly drove me round to see some of the sights of a lovely countryside that not even the bad weather could spoil, and [ then took the night train to Johann esburg where I spent the weekend with friends and on the Sunday was most warmly welcomed and entertained by Mr. Gardner Williams (the Pri o r), Mrs. Lanham ( Pr iory Secretary) and others.

Down - then up again

My non-arrival by air in Malawi made me feel most embarrassed, for the large reception party that had most kindly assembled to greet me at the airport saw my plane come down , skim low over the run way and then turn upwards and disappear into the clouds. But when I eventually landed five hours later (after a temporary diversion to Salisbury) I was relieved to be told by Colonel Lew is (Chairman of Council) who was nobly there to meet me , that the pilot's decision was absolutely right, because the abnormally strong cross-wind would have made an attempt at landing very dangerous.

When I wrote la st month from Africa I was having a hort holiday interlude with friends at Nongoma in Zululand. But St. John followed me wherever I went, even wh e n I least expected it!

Whil e s taying at Nongom a I met, on a purely soc ial occa ion , the personal secretary of Chief Gatsha Buth e ezi (Chief Executive Offic e r of the KwaZulu government), an d to my immens e surprise

In the afternoon [ was taken by Me Rothman , the D i trict Commissioner, to visit the Indian Nursing Divi sion where I received a tremendous welcome and met 1M Sara Manilal who wa wearing the Silver Life Saving Medal which had recently been presented to her by the Pri or, and I way able to give her a personal copy of the August R eview in which her very gallant action wa described. By the time that you read this, Saras will I hope have tarted nursing training for State RegislTati on at a hospital in Cape Town.

In the evening [ returned to St. John HQ where member of the European

I was taken straight to a cocktail party at the house of Mr. Gordon Mann (Chief Commissioner) where [ met a large gathering of St. J ohn people in Blantyre and Limbe; and the following morning [ set off with Messrs Mann, Salt and Ny irenda on a delightful 230-mile journey 111 a small Pi per-Aztec aircraft to a working lunch with the H on. John Msonthi (Chief Commi sioner) at Kasumu. Mr. Mann and [ spent the night in a rest camp at a Game Re serve where we saw no game but did a lot of St. John business some of it quite unexpected, for the R anger and his wife and one of the Game Wardens were all most insistent that St. John should run an Association course for them so that all their staff in the Game Re serve could be trained in first aid. Thi was a timulating challenge to which I hope St. J ohn in Malawi will respond at the earliest possible opportunity.

My remaining two days in Mal awi included an inspectIOn of the newly re-formed and very keen Bl antyre Ambulance Di vi ion, a lunch talk to Blantyre R otary Club with about 40 member pre ent, a visit to a tobacco auction and the first aid po t and chnic at the Imp erial Tobacco Group factory, and a most interesting tour of Queen Elizabeth H o pital in Limbe. Then I et off for K enya, where an even fuller programme awaited me than I had had so far. But of that if you are not already weary of my wanderings I mu t wait till next month to tell.

Ambulance Driving PART

THE PATIENT , THE ATTENDANT' AND THE VEHICLE

TWO

by M. V. Moring

One of SJA Southend's ambulances leaving the HQ on an emergency call. Th e author is secretary of the division

ear lier with nothing achieved on th e way. 1t IS virtually impossible to do res u sc itation effect iv e ly in an ambulance travelling a t speeds unsuitable to road conditions, ie over 30 mph in residential areas. Corners s h ou ld be taken slowly, widening the turn if necessary to prevent roll. An ambulance driver must a lw ays be acutely observant, noting patches of bad or repaired road surfaces, pot-holes or man-h ole covers, all of which when crossed at spee d violently bump the vehicle, aggravating the patient' co nditi on. He s hould try to adjust his speed in heavy traffic, or approaching traffic light s or hold-up s, so that the traffic is on the mov e again before he has to stop. This eliminates unnecessary brak.lI1g.

O N NON-EMERGENCY CALLS it may be better to take a longer route to the address so as to position your vehicle on arrival in the direction of your destination; this particularly applies where there are one -way road systems (the pat ient does not want to be in the a mb ulance any longer than necessary).

H aving arrived at the incident, position the ambulance with a clear exit, facing the direction of departure, with rear doors closest to the patient or the patient's likely exit from a building.

Avoid reversing or 'three point turns' wi th a oaded ambulance. If you have to p ar k the a mb ulance off the made-up road m ake sure that the drive wheels are on fir m ground. Always consi d er, especially a t the scene of road traffic accidents

CR T As), the presence of further dangers.

Use the vehicle to protect the scene, if this can be done without making it vulne rab le. R emember the presence of p assi ng vehicles when getting out of the a mbul ance, so use the nearside, or rear d oors if necessary, especially on motorways. Try not to obstruct other roa d-users an d so cause unnecessary traffic jams.

At m ost incidents the atten d ant shoul d assess the situation while the drive r is opening the rear doors an d prepa rin g any specia l equip m ent that is kno wn to be req uire d , eg oxygen equip m ent, stretcher. Havin g d one this the driver can t h en join the attendant to assist at the scene. At h o u se re m ova s it

Having assessed the situation and carried out any necessary treatment , the attendant plans the removal of the patient. This may be a straight forward lift onto a stretcher, as in the case of a road accident, but it may be more complicated such as the removal of a back injury from a third floor flat. Then the atten d ant usually confers with the driver, who has probably had experience as an attendant, as most am bulance crews alternate between driving and atten d anting. The attendant, however , is in charge of the case.

O nce the patient is loaded, the driver m u st make sure that all doors are properly closed and that the pa tien t, attendant and anyone else travelling in the ambulance is safely positioned P atients in varying degrees of u n conciousness are best transported in the recovery position, as it is rather difficu lt to change the position while on t h e m ove, a l though this may have to be done . T he d river is then ready to receive any instructions from the attendant regarding the journey or the patient's condition. If any relatives are following in

12 might be better, except when there is a prolonged delay, for the driver to wait at the vehicle for the return of the attendant. Drivers do get lost looking fo r their attendant, especially in crowds, shops or factories with several entrances, and housing complexes. When a call to such a place is received ask for someone to meet and direct the ambulance, particularly at night.

their own vehicles make sure they know where the patient is being taken.

En route the driver should keep a check on what is happening in the rear of the am bulance by USIng t he in terior mirror. He will then k.now if the patient IS requiring further treatment, necessitating slowing down or stopping. Many patients vomit during an ambulance journey , due to a combination of shock arising from their condition and the vehicle's motion.

The latter ca use ca n be reduced by careful driving It m ay be necessary during the journey to forward a message via radio to the hospital advising them of the patient's condition. It is better to use th e radio when the vehicle is s tati onary, bu t al ways remem ber to pass a tactful message so that if the patient overhears it he doesn't become alarmed.

In most cases, including emergency calls , the journey to hospital or whatever the destination does not require speed but careful, considerate, driving. Very few circumstances demand the use of lights 'Or horns to exceed the spee d limit , although th ey may be used to c ear a route in heavy traffic. Unne cessary usc of horns, sirens or beU will only alarm the conscious patient or relativ es, thus increasing shock. For this reason th ese appliances should be turned off before arriving at a house. It is better to take a few minut es longer to reach your destin at ion, and so allow such important procedures as resuscitation to be carried out effectively en route, than to arrive a few minutes

Wh en a patient is recumbent on a stretcher in an ambulance he is usually in a relaxed state bodily. An amb ulan ce braking sudden ly produces a forward force, momentum , which is suddenly arrested causing a recoil force. Many examples are quoted as to the violence of such force, particularly in connection with seat belt<;. The effect of this force on the patient can be critica l If not fatal. The internal organs lle in cavities formed by bone and muscle, and when braking occurs mom entum throws the organs forward lTI their cavit ies; the brain strikes the inSide of the sku ll and the contents of the abdomen are forced up into the thoraric cavity, compres ing the heart and lungs. The recoil or rebound force, together with the elasticity of the connective tissues, then pulls them back to their original sites with the nsk. of rupture t o the organ or its a sociated ve sels (in particular, to the liver or spleen, which might already be weakened by th e cause of the paUent's condition). Therefor e sudden braklllg must be avoided at (1// flIl7es With a loaded ambulance. This can be done by skilful driving. Driv e at a distance from the vehicle ahead that you can see to be afe and in which you are able to pull up slowly to a top this becomes more import ant with the severity of the patient's condition.

The ai m of the ambulance driver is to proceed without topping unnecessarily even if the Journey takes longer. Spinal injuries , for instance, may need to be carried at exceptionally low speeds, with lights and horn clearing the road so that th e driver need u e his brakes only minim a lly Skilful use of gear can low the vehicle, and on ly gen tle acceleration s hould be used. With a police escort, make sure the police dnver know your intended speed and route. And at all times expect the un expected from other road-users and from your patient.

Pre caut ions and equipment

Much has been said and written about the use of seat belts for both car drivers and passengers. However , seat belts themselves can be d angero us to the

ambulance driver if not us e d cor re c tly. The belt mu s t be adjusted correctly: When fastened the buckle or clasp should be in such a position that it will not pull up into the abdomen or lower ribs and so cause injury (many instances of ruptur e of the spleen have resulted from this fault in adjustment). The belt must be tight eno ugh to give support and stay in place, yet loo se enoug h to give complete freedom of mov ement. The writer has had expe ri ences with the inertia type of belt, which tends to lo ck s udd en ly when the front of the ambulace dips when cornering. When not in use seat belts should be stowed on clips and not allowed to trail on the floor. A recent 'AA -Drive report confirms the writer's views that seat belts without the use of head rests or exten ded-ba ck seats can be lethal due to the whiplash effect of the sku ll and neck. Headrests or extende d-b acks mu st be high eno ugh to support the skull adequately at eye level.

Sun visors are a useful accessory to any ambulance. External mirrors are obligatory on all ambulances, the split image type giving better coverage. An interior mirror is essential. Although it does not give a good view of the road behind, it will enable the driver to know what is happening with the patient and thus to adjust his driving acco rdingly Driv ers who consider movemen t in the back of an ambu lanc e to be a distraction do not possess the necessary concentration so essential to a good a mbul ance driver.

Unfortunately Brigade Regulations do not exempt am bulance drivers from wearing hats. For wearing one while dnving can be dangerous, as some of the taller drivers have found when they've

.knocke d their hat over their eyes by hitting something on the cab roof such as the radio equipment; and it has been known for an unco-operative patient to reach forward an d knock off a driver 's hat! Also a hat that is too tight a fit can cause headaches, which affects concentration. But hats can be useful when driving; as protection against head injury, or in the absence of a visor to shield the eyes from the sun. An am bulance driver shou ld be able to choose whether or not to wear a hat when driving.

All ambulances should carry a pair of flu orescen t jac kets for the cre w to wear at the scene of an accident in bad light or fast moving traffic In cold weather they should also wear gloves) not only for their own comfort but so that when they remove them to handle a patient their hands are warm. Gloves, then, should be part of the ambulance equip ment. Finally the vehicle itself should always be in sound mechanical order, which is achieved only by regular servicing and safety checks by qualified me chanics The driver must report any defects, minor or otherwise, to his superior or the me chanic. He should regularly check all lights , indicators and e mergency warning devices. A grill-mounted blue flashing light is more visi ble in daylight to the ca r driver, by the way, than the roof-mounted beacon. The addition of 'crash flash' or hazard warning lights - a ll four indicators flashing simul taneously is also an inexpensive and ideal accessory for every ambulance.

But of all the equipment for an ambulance, the most valuable is a careful, considerate and intelligent driver. (En d)

MRS . KATHLEEN HUNTINGTON

EVERYONE who know Kaye Huntington felt a deep and personal sense of loss when she died, mercifully very suddenly of a heart attack, on September 26. Her St. John career covere d nearly thirty years. For four years during the war she worked in the Prisoner of War Department at Sl. James's Palace and then came to St. John Ambulance Headquart ers, where she remained first in the Cadet Department and then on the Superintendent-in-Chlef's staff, until her retirement in 1969. She was a most conscientio us and devoted worker and cheerfully took on any co mmittees or commitments that others tried to avoid!

She will, however be best rem em bered for her really au tstanding charm of character. As one of her friends put it: She had almost every virtue. She was generous kind considerate tactful; had a great sense of humour and trem e ndous courage.'

Her life was not easy. One son was killed in the Far East while a POW and her other son was also a POW She was a person who never thought of herself or expected others to worry about her troubles; she took what life brought without complaint. Many people, both young and old, will remember with gra titude her wise counsel, her sympathetic interest and understanding of their difficulties and her gay and infections giggle. She always said she considered herself blessed with her friends, but it was indeed they who gained most from her friendship.

Kaye remained cheerful and happy to the end, content with her surroundings, keenly interested in the lives and welfare of her friends, and loved by everyone with whom she came into contact.

The following quotation aptly describes her : 'Where she made a new acquaintance, she left a friend.' M. B 13

I HAVE JUST returned from

GOING DUTCH

by

origin) and ass isted by a nood of interpreters O v er h e next two hours 3S gu ests arrived. We we r e eac h all oca ted a guest a nd from that moment we were their hands, eyes, compa nions and friends even to the exten t of sharing the same s leep i ng quarters. O u r two guests spoke Eng lish 'a little bit', and before bedtime we were as jo ll y a foursome as ever went on ho liday together, having great fun over o u r language prob lem.

The days that fo ll owed were of a similar pattern R eve ill e, usua ll y at about 8am, was a hymn ung by early-rising staff. The day started with a cup of tea for everyone, and then came the job of dres ing our guests ready for breakfast, which consi ted of slices of cheese on bread, eaten with a knife and fork as we eat a cooked break fast. Bread an d ja m fo ll owed, with tea in abundance. The D u tch are great tea drinkers.

After breakfast we set off with our friends, complete with wheelchair, for a walk in the woods; or loaded everyone into a coach and went to a nearby town to shop and buy present.

Lunch was at pm, followed by an hour's rest and then an excursion or competition, such as co ll ecting wild flowers, a treasure trail or a visit to a place of interest. The evening meal was around 7pm.

Each evening some entertainment was arranged. The guests were finally tucked up in bed by IO.30pm when the staff sang at each dormitory by candlelight 'the day thou gavest Lord is ended'.

For the staff supper and a chat fo ll owed, with orders for the next day; and then to bed

Our problems with the language continutlily created amusement. J recall my husband coming to me in the dormitory and saying 'This is the 'dom's wife' thinking he was s peaking of the doctor's wife. Was his face red when peals of laughter rang out, for 'dam' is Dut ch for stupid. On another occasion we identified the words th e 100. We are all going to the 100 this afternoon,' sa id my husband 'That will make a c hang e,' said I , seeming to s pend half the day wh ee ling chairs into tho se premis es. But it transpired, amid gales of laughter, that Veluwe (pronounced veloo) is a beautifuJ palace much used by Queen Wilhelmina and now the home of Princess Margri et! When we got to Veluwe we found a ll the sta te coaches housed there, and we were co n ducted around the sttlb l es and grounds of this magnifi ce nt building. One evening we were entertained by a group of young Dutch singers ca ll ed Th e Bnght Lights. They ang a number of folk songs in English for our special benefit, we thought. But when we went to thank them we found they co uldn't speak English and had learned th e songs parrot fashion.

Bingo , it seems, is bingo the world over, except in Holland our c hances of winning were even less as it took us a few seconds to translate the numbers

The guests did not see us 111 ul1Jform

until the Thursday, when we donned th em to me et the visiting members of the Order. We had the privilege of m eeting the founder of the Ladies' section, who also founded the holiday camp movem e nt. I presented the Ladies ' section with a pennant from the nursing members of Essex, which now hangs in the office of the Order of the Netherlands in the Hague

Soon the week was over and ti m e for us to return to England A car arrived at the camp for us at 7am, and as we went out to it all our friends - no longer staff - appeared and sang farewell in D utch, a most touching moment. Before this visit to me Holland was a land of bulbs and cheese. Now it is a country of kindly people, of l aughter and of song.

The County Sec.

' YOU MUST ADMIT , DAD - IT KEEPS HER HAPPY'

YOU MAY NOT have noticed thIS but nowhere in Brigade Regulations doc it tell you in any detail how to be a county secretary. Originally never intended to be one. I wanted a bttle Job to while away the afternoons. I had been a secretary I could typc The advertisement appeared in the local paper at just the right moment. Or so I thought. 'Secretary wanted part time. Hours to suit applicant.' What could be better?

The interview everyone pleasant. D uties? varied. Mostly dealing with forms. I cou l d do that surely? Typing of course but the Commis ioner came in only oncc a week; no pro blems there T here would be the odd meeting at which J would take down the minutes Of

course one would be expected to appear at such things as competitions, inspections and the like - all very enjoyable, I was assured. Meeting new people every day. A new life. I would do it

Disillusion set in early. It was now October. The County Secretary Mrs H. would s tay until May to get me launched. I did wonder at the time why it was going to take a long. I soon found out. Every day [ arrived willing, even anxious to learn. Every night I crept home. my mind in a whirl of Form BF 1, BFC I , BF4 , BFC4; was there any difference? Visitors would call at the office; conversations took place not with me I cowered at my desk, tunned by the talk which flowed over my head

and which I did not understan d Were they in fact even speaking English? Obviously I was not equipped to cope with this complex worl d

A black day when Mrs H. had to b e away on jury duty. I was on my o w n, dreading foot teps outside the d oor, or worse the telephone. B ut it ra n g of course. A voice bitterly complained that something or other had not been returne d to him after hi inspection. Clearly he was not surprised by this omission; w ho could blame him? But what was it? A P ara d e what? State? I would enquire an d let hi m know. He rang off, dejected. Then came the announcemen t that of course I would wear uniform Uniform? Me? What would my family say? My friends? I was soon to find out. Jokes

Ethel L ytha m, Area Sta ff Office r

The County Sec. (contd.)

abo ut acci d ents on the M 1 when I, resplendent in my new uniform, would be the sole hope of the injured. There was nothing for it. I would have to learn fir aid.

Enrolling and taking the course.

Actually passing the exam. Pl eased with mys e lf in my finery; until the day my husband came home to say that an acquaintance had stopped him in the street, remarking } didn't know your wife was on the buses. No matter. I had a uniform and a first aid certificate and, in du e co urse, a warrant Unfortunately even this moment of glory was dimmed; on the day I took the warrant home our dog, unimpressed by my new status (and taking his revenge no doubt, for lonely afternoons), took it from a low table an d chewed it up'

The weeks came and went, and so did the forms I unfailingly sent out to the wrong people. H ow long suffering they all were! On e day there was the pained voice of a corps superintendent gently pointing out that he would prefer me to send warrant s for the officers un der his co mm and direct to him. He did not feel, he sai d , that there was quite the same dignit y about the occasion for a man to have his warrant arrive on the breakfast table with the gas bill. I promised to try to do better.

One day th e post box was full of package, large and small. Wha were they'! R eturns 1 was told firmly, Returns? We were to'scrutinise eac h record card and confirm the member's efficiency. As every St. John m e mber] h ad met so far had ee m ed terrifyingly efficien t, to me this eemed entire ly superfluous I would also please note whether AIM Bloggs was due for a service medal or bar. 'How would I know'] I could count up to 15 COUldn't I? Or 20, 25, 30? Also would I plea e check date of birth to see who was 65 Why? - Did it matter? Were they going to have a present? No; the Commissioner's approva l to be retained on the Active List. Aged 70 or over those cards would go to London with a medical certificate. What went on in London I had never d ared to enquire. Letters , forms , notices, warrants and the like ca m e from t her e with aJarming regularity, and were dealt with by Mrs H. with speed and ap lomb. Would I ever achieve this efficiency? It seemed unlikely

Competitions loomed. D octor now appeared with bits of paper they called 'marking sheets'. I was to type these in readiness for 'the day'. Invi tations wer e issued, cups a nd trophies gathered in. The divisional superintendent of the local nursing division asked if she and her ladies would as usual 'do' the teas What if she said no? Th e school caretaker to be contacted a delicate operation this fraught with peril if we had displea ed

The Lamb and

the Flag

him the previous year. At la s t, order appeared out of chaos and the thing was under way, and fina ll y over. The thought that next year all this would be my job on my own was hastily pushed into the background. For I had more immediat e problems , for Mrs H. had now left. I was alonc. I was a County Secretary.

I waul d like to be a bJc to say lha t I immediately became a model of efficiency. But learning the job was a slow process. Gradually light dawned. I could now recognise the variOllS forms, that never ending tream that appeared daily on my desk. Name on paper became people, real people who actually did the real job of St. John carrying out the first aid dutics that came their way. There were times when J did not recognise them, so different do we all look in uniform, meeting Mr. X in th e office in ordinary c lothes had not prepared me for the resplendent figure he made in uniform and medals at an inspection.

As I was promised, I have met a lot of people. And how kind they have all been I sometimes wonder what happened to the part-time job that was to help me while away those lazy afternoons Lazy afternoons?

But as I overheard my daught er murmunng to her father recently Well you must admit, Dad it keeps her happy.

Charming.

I WONDER how many people know that the emb lem of St. John the Baptist the Patron Saint of the O rder of St. J ohn, becam e a popular inn sig n , the crest of a City Livery Company and a R egimental Ba dge of the British Army? Also what the emblem symbolizes?

In the early days of pilgrimages wealthy travellers were the guests of the abbeys and the monasteries , but for the poorer pilgrim there were no lodgings available until the religious houses began to build hospices or hostels, usually adjacent t o their own b uild ings. Each hostel had a sign associated with the religious house responsible for it. And these signs were the origin of many inn

or earlier, the company being en titled 'Tay ors and Linen Armourers of the Fraternity of SL John Baptist'. The chapel of Sl. J ohn Baptist in Sl. Paul' s Cathedral was granted to the Company for daily service and prayers. Their arms date from 1480 and their hall was in Threadneedle Street, which takes its name from that facl.

Charles ] r married Catharine of Braganza in 166 I and Bntain acquired Tangier from Portugal by marriage-treaty. The 2nd R egiment of Foot was formed by the Earl of Peterborough as part of the garrison to protect Tangier from the Moors. The Regiment was known as the Queen 's Roya.l Regiment and took Catharine's crest, the Lamb and Flag, as their badge.

When I was a boy before the First World War the Lamb and Flag was the badge of the local Territorial, the 4th Battalion of the Queen 's Royal West Surrey Regim e n 1. Reminiscing with a contemporary recently, he reminded me that we caJ1ed them the 'Mutton Lancers'.

During my last year at chool in 1915 an Army Cadet unit was formed, affiliated to the Queen's , and our cap badge was the Lamb and Flag. It was then that I acquired some knowledge of the history of the Regiment and how it was formed , bu t the origin of its ba dge was unknown to me.

Dunng the Second World War 1 was wearing thiS badge as an officer in the Home Guard, and at the time a book called 'Badges and Emblems of the Servi ce' was published. [n it the badge of the Queen's wa de cribed as The Pa schal Lamb with the Banner of St. George. I have recently learned that both the e de criptions are not strictly correct. The P aschal Lamb wa the lamb without blemish which the Jews sacrificed at the Feu t of the Passover, or Paschal, to commemorate the redemption of Israel from Egyptian bondage.

LAMB AND FLAG

This sign is the crest of the Merchant Taylors' Company, founded in the 13th century or earlier It is also the emblem of St John Baptist, the Company being entitled Taylors and Linen Armourers of the Fraternity of St. John the Baptist.' The ch apel of St. John Baptist, in St. Paul's Cathedral was granted to the Company for dally se rvi ce and prayers. Their arms date from 1480 Their hall was in Threadneedle Street which takes its name from the fact. The sign is often shortened as 'The Lamb' but also appears as 'Lamb and Crown: etc

THE QUEEN'S ROYAL REGIMENT (West Surrey) Formed in 1661 by the Earl of Pe terborough, the 22nd and 24th London Regiments (The Queen's) were part of the corps of this regiment Badge The Pa schal Lamb (crest of the wife of Charles II, Catherine of Braganza, after whom the regiment was named) with Banner of St George

SARACEN'S HEAD

A very old sign, found in all parts of England In the Middle Ages Saracens meant Moslems. So in Shakespeare's Richard II Many a time hath banished Norfolk fought, Streaming the ensign of the Christian cross, Against black pagans, Turks and Saracens. So the Saracen's Head became the crest or part of the armorials of over fifty distinguished and noble families, including that of Lord Cobham, K. G ., circa 1320. The sign was sometimes adopted in honour of one of these noble families, but probably more often to signalize generally the valour of the Crusaders.

LAMB

The blood of a lamb without blemish was commanded by God to be sprinkled on the doorposts of Hebrew homes in Egypt so His destroyi ng angel might pass over and spare Israel. This was memoriali ze d in the Passover Festival.

PASCHAL LAMB

CREST, AND REGIMENTAL BADGE

the coat of arms of the Templars, who became established in England in 1180

The Order was founded in Jerusalem to protect the pilgrim routes , and were known as the Knights Templars because their Monastic buildings were near to the site of the Temple of Solomon Originally they wore a white mantle with the Crusader's Cross on the left shoulder. Wh en driven from Palestine they lost their sense of purpo se and were abolished by Papal decree in 1312 their property being transferred to the Order of St. John.

THE EMBLEM OF ST. JOHN - INN SIGN, igns some of which are still in use today. The Whit e Hor se, at Dorking for instance and the Angle. at Grantham, which was founded by the Order of St. John. Religiou s fervour for the Crusades was indeed respon sib le for many inn names and signs. Trip to J erusa lem, Saracen's Head Turk's He ad, Lamb and Flag, Lamb , and Lamb and Crown are typical of many still numerous throughout Britain . The last three all have the same sign, the emblem of St. John the Baptist, which is a lamb standing supporting a banner and being cro wned with a thr ee ray numbus

Eric R De lderfield in his book on British inn signs states that this was also

The em blem of St. ] ohn the Baptist is also the crest of the Merchant Taylors' Company, founded in the 13 th Century

According to the Gospel of St. John, Chapter I St. J ohn the Baptist seeing ]e us coming toward him said 'Behold the Lamb of God which taketh away the sin of the World'. So the lamb in his crest represen ts his cousin ] esus. The three rayed nimbus about its head indicates deity. The white banner with the Cross of Christ in red symbolizes the joyful victory over death won by o ur Lord. No doubt this is the reason why lhe flag of the Church flown on Ea ter Sunday became the Cros of St. George and the Fl ag of England The lamb standing with the banner of Vi ctory suggests the victorious nature of the acrifice.

The stained glass window at St. John' s Gate, Clerkenwell, depicts SL John Baptist holding the banner of the Ord er of St. John our distinctive symbol of victory. At his feet stands the Lamb of God.

lJohn E. Dan e)

BANNER

A banner is the symbol of rejOicing and of victory. The Lamb of God bearing a banner with a cross symbolizes the joyful victory over death won by our Lord

RED CROSS ON WHITE FLOWN ON EASTER SUNDAY

THE LAMB RECLINING ON THE BOOK OF THE SEVEN SEALS

The Revelation 5 1 Reclining because He is the Wounded Lamb The three-rayed nimbus denotes deity

THE LAMB STANDING WITH THE BANNER OF VICTORY

No longer wounded, but standing with the banner of victory. suggesting the victorious nature of H is sacrifice.

LAMB OF GOD

$,,1 17

,4JR WING FACTS

from Robert A. P eed l e.

I have just read the article 'S1. John take to the Air', (Review, July 1973) and perhaps you would allow me to fill in a few gaps and put the record straigh t so far as the S t. John Air Wi ng is concerned.

Your writer was correct in saying lhat its origin had two sources: our work at Epping which was evolving around the use of light aircraft for humanitarian work, as well as benefits for the Brigade such as attendant and parachute training, and that of lhe London Hospital for kidney transport.

It was during my research for my own plans, with which was helped by Chief Inspector Jim Martin of our force, who is a pilol, that I contacted the London Ho spita l. Having had dealings with this hospital in my capacity as a traffic controller at New Scotland Yard, they would obviously be able to help. By a coincidence, however, this was three days before a meeting at that hospital , separately arranged, of some volunteer pilots.

I attended that meeting and went away and drew up modified plans for my ideas. At the next meeting T took the chair and the formation of what is now the S1. John Ambulance Air Wing was agreed by all present. That was ovember II 1971,which must be considered the true birthday of the Air Wing. On that day I enrolled those present as auxiliary members of my Division in Epping. The plans presented at the meeting by myself are still today the basis for the organisation, administration and operation of the Air Wing and the function of the control room. The contro l procedure being based very much on the tried and tested schemes operated by the Metropolitan Police.

I informed Brigade Headquarters an d County Headquart ers of what I was doing in the name of St. John. The then County Commissioner of Essex, Dr. Nicholls Palmer, responded immediately supporting my schemes and transferring myself and the Air Wing to County HQ as from December 3 1971. The only significance of February 2 1972 mentioned in the article is that the control room opened on that day B efore then a contro l function was operated from my home, and some six ca ll s were received there during that period. The first flight of the Air Wing was in D ecember at the cost of £80 to Air Wing funds.

Re aders may be interested t o know that the Air Wing was initially financed by a loan guaranteed by myself and the treasurer for £500.

The Air Wing was taken under the direct contro l of Brigad e H eadquarters on January I this year, and I resigned as Air Win g Superintendent attached to Brigade HQ l ess than 2 months later. New Scotland Yard Robert A. Peedle

KEEP BEXHI LL

from John A. Alderson, Divisional Offi cer.

I would like to express my sincere thanks, and that of my cadets, for such a wonderful time at B exhill camp this year.

Everything there was immaculate, the food 5-star, plenty to do and see, and the entertainment great; in fact the R eigate ca det s won the fancy dress as the B elles of Sl. Trinians!

The camp co mmandant, Miss Willi s, and her staff did a wonderful job. We sha ll meet again next year. Keep the camp going.

Reigate John A. Alderson

READERS VIEWS

At first Sight this seems to be the answer to the first-aider's prayer, but is it going to be practicable for use on any large scale? 1 envisage situations in which the patient could be the victim of quite a different accident and lying unconscious is found by an untrained stranger who might be advised for example to givc appropriate treatment for diabetic coma or insulin overdose when the real trouble might be a fractured spine, even or perhaps some medical condition unrelated to the original ailment!

The mind begin to boggle at the ramifications but what, I wonder, would be the views of our S1. J ohn medical experts on this rn a tter?

J ava ( t emporarily)

Readers' views and OpiniOnS, which should be sent to the Editor, although published are not necessarily endorsed by the Editor or the Order of St. John and its Foundations. Although readers may sign published letters with a pen-name, writers must supply their name and address to the editor.

Ernest B. Haml ey

our last lecturer, and one that is guaranteed to keep the class on its toes. Member (intermingled with newcomers) a rc divided into groups of two and three. Each week a different s ubJectls taken, viz: beach hut "York industrial injuries, accidents in the home , sports accidents, resuscitation and finally a recap, and practical work. Each group is given a case which its members write down, and after the rest of the questions have been given ora ll y to the other groups the members work out among themselves the diagnosis and suggested treatment for their own question. A spokesman is appointed for each group, changing round each week Thus everyone is kept alert the plrit o f competition is stimulated and the doctor goes through each episo d e from a medical as well as a first aid angle and 0 puts over a comprehensive plcture of the case to the whole class :-..Iewcomer s 'latch on' and lheir interest is caught from the word Go, Mundes!ey Winifred Jeffries

THE TAPED PATIENT

from Ernest B. Hamley.

It is strange that one should pick up information so far from home (10,000 miles), but 1 thought that if it has not come to you from another source your readers might be interested to know about the 'EM I instrument. No , it's not another product of a famous recording company! Its existence was drawn to my attention by an American FAO representative here who had heard of its use in the States as a practical invention to help first-aiders.

ORDER INVESTITURE

COMMANDER (BROTHER)

Gen. Sir Rodney Moore, GCVO, KCB, CBE, DSO, (Berks.)

Bryan Reffold, MB, BS, DPIl, (Yorks.)

Thomas Aquines Casey, MCh, 1 - RCS, (London)

Michael Mark William (Berks.)

Eric Cyril I'ear, MB, ChB, (Yorks.)

Kenneth William Nicholls Palmer, LMSSA, DPhysMed, TD, ERD, (Suffolk)

Gp. Cpt. Robert William Povey, MB, BS, FRCS, LRCP, (Lines.)

Gp. Cpt. Ivan Mathew O'Connor, MB, MCh, BSc, DPM, DOMS, (Bucks.)

Ernest Ba illlamley (London)

Col. Bertrand Cotton, OBE , TD, ( Ir eland)

COMMANDER (SISTER)

Amy Kate, Miss Cord cry (Berks.)

Dons Rhoda, i\[rs. Cole (Devon)

Winifred, Miss Elli s, SR ,(Oxon.)

Ruby Beatrice, Mi Laker (Sussex)

Hilda Mary, Miss Walton (Worcs.)

Marie, Mrs. Reffo ld (Yorks.)

Elizabeth Mary, Mrs. Hodges (Sussex)

OFFICER (BROTHER)

K enneth Dyball William son (Nott .)

William James Richards, CBE, QPM, (Che hire)

Reg inald John Cameron ( ortl1.)

Gerald Strachan Pawl e (Cornwall)

Col. John Martel Hughes, TD, BSc, MB, FRCP, DPM. (Mon.)

Terence Charles Oliver (Beds.)

Thomas Simpson, LRCP & S I DPH DCH, DTM & H, (W ilt s.)

Frederick Noel Payn e (B ri sto l)

Peter John Miller MRCS, (Warwick ,)

Sir Berwick Lechmere, Bt., DL, JP, (Worcs.)

Douglas Bell (Wilts.)

William Ilenry Walker (Co. Durham)

Eric William Spooner (Staffs.)

Wg. Cdr. Matthew Shearer, MB, ChB. (Kent)

Surg Cdr. Alexander Maxwell Lawrence-Smith, RN, (Sussex)

Charle Edward Froome (Guernsey)

Harold Barlow (Oxon.)

David Gilbert Charte Inglefield (London)

Commander Sir Peter Troubridge, Bt, RN, (Su sex)

OFFICER (SISTE R

Mary D'Estoutville, Mr. Mylechreest, SR , (We tmorland)

Ivy Lilian, Mrs. Wilkins (Wilt .)

Mildred Celey, Miss Page (Bucks )

Florence AlIce, i\liss Tovey (Birmingham)

Marion, MISS Beer (Devon)

Mary Barclay, Mrs. Kaighin (Birmingham)

aney Winifred, Mr Rowlands (Hants.)

Violet Winifred, Mis Henderson r.lBE, (London)

Ir ene, :Vlrs, Rawlings ( orthants.)

Audrey Joan, Mi s Allard (Worc )

Vera, Mi s Carlton (Yorks.)

Agnes Marie, Mi Rolls (Berks.)

Joan Mare, :-'lrs. Vawer (Camb '.)

Jeanne Margaret, Mrs. Mercer (Kent)

SERVING BROTHER

Albert William Phair (10M)

Hugh Dudley Symon, BA, MRCS, LRCP, (Salop.)

Leslie George Lewis (Hants.)

Michael John Connor (Lancs.)

Robert Hayhurst Sweet (Es ex)

Dennis Harry Atherley (Notts.)

Michael Walton Ayton Haward, MB. ChB, (Somerset)

Frederi c k David Jordon (London)

George Albert Dunkley (Essex)

Irwin George Holmes (Cumbs.)

Mark Alfred Markley ( otts.)

George Edward Fear (Somerset)

Charles elson Searle (Surrey)

WillIam Frederick Shaw ( otts.)

Joseph Maughan Thompson ( orthumb.)

Alfred Stanley Elwin (Surrey)

Frederic k James Sau nders (Herts.)

Alexander Albert Bird ( orfolk)

Alfred Urch Pratlett (Somerset)

Eric Mitchell (Kent)

Peter John Douglas Warlow ( orfolk)

Joseph William Lilley (Staffs.)

Clifford Ronald Richardson (Suffolk)

SERVI NG SISTER

Helen Elizabeth , Miss a h (Kent)

Beatrice Ellen Mrs. Grainger, SEN, (Oxon.)

Lily Floren c e :-'lr5. Henne sey (Kent)

Agnes. Miss McPhail (Dor et)

Helene Duncan, :-'1r. Barlo\\' (Essex)

T11ere'a Ylary, Mi s Fit patrick (Lanes.)

Gladys :-'fis Hamylton (Lelcs.)

Brenda Alice Susan, Mi s Warwick (Essex)

Marjorie, Mis ' Roberts (Hants )

Sarah Frances, Miss Dommett (Lanes.)

Denyse Gertrude Annie, Mr Loach (London)

Lilian Vera, Miss Moore (Hant.)

Alice, Mrs Hulse (Lanes )

GUARANTEED

from Mrs. W. J effries, Divisional Officer.

We a ll know how h ard it is to hold th e interest of m embers who have taken first aid lectures year after year an d at the same time get the basic mes sage over to newcomers.

H ere, then, is a new approach to the subject, as adopted by 18

The Emergency Medical In structor (EM I ) is designed to ensure that first-aiders can sec that the correct treatment is given in ca es of diabetes, haemophilia and epilepsy. I t is a small instrument, manufactured by the National Id entification Co Denver, Colorado, about palm-sized and battery operated, to be carried in the pocket or belt, anywhere a long a the potentia patient remains upright. As soon as he passes out or collapses, the change of position ca u ses the tape (previously wordcd as a m essage from the patient s medical adviser, by the manufacturer) to play and give instruction on what to do or more often what sho uld not be donc. It costs about £53.'

Arno l d Mi chae l Syms (Berks.)

Ronald John Bray (Cornwall)

Henry Baxby (York .)

Harry Percival Teague (Dor et)

Charles Alfr ed Freeman (Kent)

John HelUY Wedd (Nolls.)

Walt er Collins, BEM, (Essex)

Frederick Alec Felgate (Suffolk)

AICred William Bines (Middx.)

Phi.lip Edwin Jame CUlting, MRCS, MRCP, MB, BS, MD, (Suffolk)

Clive Wilfrid Pierson (Wilts.)

George Donald Wilale (London)

Robert Linge, QPM, (London)

Albert Bennington ( otts.)

William Leonard Haffenden (Buck .)

Alfred James Tull (Middx.)

Lionel Harri s (Lancs.)

Arthur George Eley (Surrey)

Bruce Turner (Notts.)

Leonard Whitworth Read (Essex)

K enneth WiUiam Walker (Somer et)

Char les William Plimmcr (Essex)

Kenneth Efle Taylor (Notts.)

Alfred Croft (London)

Laura Edith, lr. Payne (Leics.)

Dori Margaret Mary. Miss Bu hnel!. RMPA, RM ,(Surrey).

Maria Agnes, :-"lr Palce (llant .)

Renee, Mrs. Warburton (Lanes.)

Cissie Gwendoline, Mrs. Faulkner ( otts.)

Diane aney Millicent, Mrs. Seceombe (Middx.)

Gladys Mary, Mrs. Parsons (Hercfordshire)

Nellie, Mrs. Mar hall (Lancs.)

Brenda, Irs. Williams (Hert ,)

Jean Gwendoline, Mrs. POItas (LlIl c s.)

Hilda J es , ie, Mr Morgan (London)

Mabel Florence. Mrs. Harrison ( orfolk)

19

From The Electricity Council's Ambulance Bulletin

NEWS from SCOTLAND

Unsi ghted - not blind

IT WAS OCTOBER last year when the villain of the piece made his first move. The crisp, military tones of Bill Munnoch on the telephone inviting my wife and myself to meet a very interesting person did much to dispel Monday morning blues. Spry of figure, kilt-clad, perfectly groomed and bubbling with enthusiasm, Bill greeted me at the door. Think of the average bank manager, gleaming white hair, matching moustache and boundless vitality, that is Bill. I was ushered into a spacious living room where a welcoming fire glowed in the hearth. By it sat a man in his late fifties, whose cheerful countenance smiled in my direction but not directly at me The Alsation dog at his feet made me realise that he was blind. Thus I met David Scott Blackhall, writer, broadcaster, champion of the blind and founder of the Milton Mountaineers - a band of blind people who meet once a year to climb a mountain. Their first sortie had been Ben Nevis and, staying at the Milton Motel, they took this name for their organisation. Still reeling from the shock, I heard myself agreeing to take the Milton Mountaineers up Lochnagar.

In the cold light of a sombre July morning I drove past Lochnagar from Braemar on my way to meet the party. Already menacing clouds were colliding with the summit and spilling their grey entrails into the coire. I was filled with nusgIVmgs and already imagined the headline - 'Blind Climber Missing on Loc h nagar'. I walked into the dining room of the 'Tink' in Ballater, fully expecting to be the object of 'breakfast consternation' in my somewhat disreputable hill garb. But not one face turned in my direction. 'Good heavens' [ thought, 'this is my party'. I saw a m;ss of summer-clad people without a hint of mountain climbing about them I felt like running away but it was too late; Bill Munnoch, beaming and happy, had spotted me and a round of introductions began. I extricated myself from the fiesta, having obtained a promise that everyone wou ld be at Loch Muick Car Park by lOam, and went up to the Spittal to meet the team. There followed a ha:sty half-hour of sorting out one guide for 20

each blind person, and weath erproof clothing for each in the party.

The Milton Mountaineers arrived as a chill wind bent the trees and threatened rain at any mom ent. We went by Landrover to Gla Allt where, as guides and guided were paired off, the c l ouds mira culously vanished, the wind died away and a day of mountain perfection was upon us.

By the time we reached the Glas Allt falls, we were no longer guides and guided, but a party of friends, giving to each other the experience of a lifetim e.

The miles slipped a way virtually un-noticed ; soon we were within sight of the summit; and faintly there carne the strains of a lone piper. It wa s Maurice Lovell, an ex-Pipe Major from the Scot Gu a rds , who had gone ahead with his escort to welcome the party to the top , a fitting climax whi ch matched the exhilaration everyone felt.

On the descent, frien dships blossomed and it was a tremendoLlS experience to talk to one of the party who d escribe d in detail the views he had 'seen' from the sLlmmit. It is perhaps significant that this was the only group of walkers I have ever had on a mountain who made not one complaint, although one or two of them must have had sore feet. It was agreed that on the Sunday we would go up the Bein a Bhuird by Landrover and so rest aching muscle s.

When my team met o ur guests on the

WALES

Sunday morning we were surprised to find that the whole party had turned out not just h alf of them as we expected, there was a s hort age of transport.

An anxious Bill Munnoch surveyed the spectacle of extra Landrovers arriving to convey the whole party up the mount a in and was greatly relieved when informed that they were all 'lent' by friends. As I clim bed in to the front of the final Landrover, a bottle of bribery carefully stowed in my jacket , one of the nota bIe characters of the party leaned forward

'I'm glad I came with you, Bill' Duncan Simpson is the only p e rson I have met who could 'hear' a bottle of whiskey

Following a successful trip, complete with celebration drams at the top, the Milton Mountaineers invited us all to dinner and we made the fatal move of accepting th eir invitation.

A fter a very pleasa n t meal, a cei lidh began, but although we had pipers and pianists , we lacked a guitar. But [ acquired one through friends in Ballater , and when it arrived, I heard Bill Munnoch whisper, I don't know how it's done, but it usually costs half a bottle'.

The supreme moment of the weekend came for me when David Scott Blackhall, in thanking us, laid the ghost of George L eigh Mallory, on why people climb mountains: 'It is not because it is there, but becau e we are here'.

W. A. Marshall (A berdeen Mountain R escue Team)

OVERSEAS

AUSTRALIA

L to A) Sydney's 12-day Aoyal Easter Show, attended by 1 Y, million people, is always well covered by the Brigade - both humans and animals

Combined

At SJA Holyhead, Mrs Levi Williams unveils a plaque on a tent given to the lo ca d ivisions in memory of the lat e Mr Levi Williams, Anglesey County Staff Offi ce r. ( Photo J. C Davie s, Holyhead)

Brigade Secretary for Wales, Mr. C. J Parry , with his family, (L to A Mrs Michael Parry, Mrs. C J Parry, Miss Annette Par ry, and Cllr Michael P arry, outside Buckingham Palace after receiving the MBE (Photo Topix)

News from Divisions ICentres

Retiring presents for Lincoln Nursing Division's Mrs I Scott, 0/0 (left) and Mrs. G. Coulson, N / M, who joined the division in 1939, from Mrs Frances Hodges, County Supt. (N). (Photo: Lincoln Echo)

Haslemere nursing cadets about to leave for Alton hospital, with Mr J. Levett, where they are helping on the wards

CHES HI RE-Almost 200 ambulance and nursing cadets from 20 divisions, accompanied by their officers, attended the 25th co nsecutive cadet camp at Penaenmawr, North Wales August 17 to 24, under the command of Me. R. A. Fielding, County Staff Officer (Cadets)(A).

During the week 112 proficiency certificates were gained in ca mping map reading or ro ad and home safety, but apart from the hard work involved the ca det s enjoyed a treasure hunt, rambles, bathing a barbecue on the beach and

Lancs'

an evening trip through the Llanberis Pas, where a demonstration was give n by the Snowdon Mountain Rescue Team which included a visit to their headquarters at Nant Peri s. Th e highlight of th e week was on Thursday when the camp was visited and inspected by the th en Commis ioner-Ill-Chief designate, Major General D S. Gordon who, after inspecting the Guard of Honour, spoke individuaUy to many ca det s. General Gordon also cut (see O ctober cover) the special anniver ary cake, which wa

later divided into 200 pieces, a piece for everyone in ca mp.

General Gordon watched an exercise, wh ich took place durin g an eve ning ramble, involving the use of two ambulances, and a lso enjoyed 'hot dogs' at the barbecue before leav in g and so en d ed a day which will long be remembered by me mbers of Cheshire.

KENT-14 nursing cade t s, average age 12Vz, one a pint-size 8-year-old, raised £55 for divisional funds on a recent LO-mile sponsored wa lk

Some of the cadets took their dogs aJong, two of the youngest had to be bribed w ith orange squash after only Y., of a mile, but eventua ll y they aU comp eted the co ur se to tuck into au age rolls an d hot emon. Great. they said.

NORTHANTS-Wh en cadets ofWeUingborough Area decided to hold a harvest thanksgiving ervice they did not expect the Wellingborough HQ to be so crowded, a this was their first venture of this nature.

The hall presented the uSLlal harvest feslival appearance with an array of nowers, fruit, vegetables and groceries; the centre piece being a massive pumpkin. Harvest hymns were sung and an address was given by the superintendent Methodist minister. The gift were distributed by the cadets to elde rly people in the town and a co lle ction wellt to the Rushton Hall School for Blind Childr en. Div. Supt. Keith Loveridge surpri sed at the Sile of the gathering, welcomed everyone and said it was hoped to make tillS an annual function.

Cadet Leader Valerie Timlin, of the Thrapston Nur ing Cadet Division, added cons id e rabl y to her programme of duties for the year when she was elected Carnival Queen of the town. The carniva l parade over which she reigned included a n oat representing the ac tivitie s of S t. John; she lat er had the of presenting the divi ion with an award

Division members Mr Robert Hall and Mrs. Hannah Rothwell, both cadets to divisional superintendents, are congratulated by Area Supt George Wooton when he presented them with 45 years' service certificates recently NATIONAL FIRST AID COM PETITION

ndustry , held London,

REVI EW CROSSWORD No 11 (73) Compiled by W. A Potter

ACROSS:

1. Visually examines opimons. (5). 4. Worried and apprehensive, although having a ickne s in comfort. (3-2-4). 9. Active fever in which the pyrexial signs are particularly marked. (7). 10. Unusual combination of 27 down and 30 down is a great success. (7). 11. Coagulated blood. (4). 12. Relates to bone from outsize broken toe. (5). 13 Story of heroic actlOn. (4). 17. Bear suffering with fortitude. (6) 18 Secular bone. (8). 19. First given by the SJ.A.B (3). 20 Broom hid in a muscle of the back. (8). 21. Part

ST JOHN REVIEW

To Review Sales, St. John Ambulance, 1 Grosvenor Crescent, London, SW1 X 7EF.

Please supply/renew * years subscription to the St. John

Review commencing with the issue. I enclose .for years

£7.70 including postage for one year.

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• Delete whicheve is Inapplicable

Reduced r ate for bulk orders (minimum 6 copies) from St. John

(CounCils, ASSOCiation and Brigade) in the U K. Details from Review Sales.

of the foot and upper eyelid. (6).24. Secured a variation of diet. (4). 25. Flexor of thigh shown by police officer on active service. (5). 26. Path ological growth as in manuscript. (4). 29. Surgical procedure for arrest of arterial bleeding. (7). 31. Where fibres of left and right optic nerves cross in optic tract. (7). 32. Line of union of developmentally separate bones. (9). 33. Mother, accompanied by son, is worker in stone. (5).

DOWN:

1. Blister a result of strange vices followed by the French. (7). 2. Takes a part in formation of nasal cavity and walls of the orbit. (7.4) 3. D ecline to a lower state of health in the scullery. (4). 4. To open an abscess surgically is nice change. (6). 5. Around there is a boy ready to be shaved. (8). 6. Hint taken wrongly to describe one of slender physique. (4). 7. Limb of a fighting service. (3). B. Alec hit wildly in accordance with the accepted code. (7) 14. Ales and spirits mixed to produce intestinal movements. (11).15. Racial group with central rib. (5).16. Jack whose diet was devoid of lipoids. (5). 18. To be taken three times a day as on the prescription. (3). 19. Cavity lightening facial or skull bone. (3.5) .2 0. Rota set back is making revolutions. (7). 22. Experience an injUry with discolouration after Sunday. (7). 23. Cleans dismantled and re-constructed surgical instruments. (6). 27. Spinal cord of animal in stems of plants. (4) 2B. Surgical team is unyielding. (4). 30. Strange spirit. (3).

SOLUTION TO CROSSWORD No 10 (73) ACROSS:

1. S.a.1ine; 4. Lord.o.sis; 10. Obe.sit.y; 11. The.atre; 12. Peel; 13. Beri; 14 Ba.sic 16. Normal; lB. Disease; 22. AnLa.cid; 23. A.taxi.a; 26. Imag e; 28. Echo; 29. P.ang; 32. Two feet; 33. Fatigue; 34. Ligature; 35. Sponge DOWN:

1. Stopping; 2. Liege; 3. Nail ; 5. Oste.iUs; 6. Deep breath; 7. SUes; 8. Speech; 9. Ryles; 15. Management ; 17. Run; 19. Six; 20. Director; 21. Gang.rene; 24. Distal; 25. Sha.ft; 27. Among; 30. Argon: 31 Step.

St. John Ambulance Tour M ay 1974

Express Boyd Ltd. are pleased to announce another tour next Spring to Syria & Cyprus. The itinerary is:-

DAMASCUS: MAY 11th & 17th

PALMYRA: MAY 12th & 13th

ALEPPO: MAY 14th & 15th

LATAKI EH: MAY 16th

NICOSIA: MAY 18th to 24th

A full programme of tours has been arranged in Syria to include visits to Homs, St. John ' s Castle in Aleppo, Krak des Chevaliers: and in Cyprus to include Troodos, Paphos and Limassol

£229.00 inclusive

For further information and bookings contact:EXPR ESS BOY..[) LTD. Travel agents to St. John (Formerly Express Travel & Transport Co, Ltd.) 4/5 Bonhill Street, London, EC2A 4BX. Telephone: 01-6286060

Todmorden

Sugge

pr i c e t o he pu bl ic per b a r

Your tot al co s pe r b a r

You n e profit p e r bar

Your n et prof it p e r out er

HOW TO SELL 15p 10p 5p 90 p

Se to al r e a ti ves an d frien d s of you O r ganisa ti on. H ave choco late st a ll s a C h ri stmas fetes, b cllaclrs an d 10Ul sa es of all kinds n ti le p e-C lm stmCls fun d r d si n g e f fo r t

Se ll b y the O u te r as t hese c!loco ate bd s make exce ll en t C h ri s t mas p r ese nt s.

HOW TO ORDER

Simply fil in th e or d e r b e ow. SEND N O MON EY W TH ORDE R Y o u will b e Irwo ce d wiler you r or d e r Cl rr IV(S dn d p a ym e nt s r equir ed thirt

We

sbe's

an elderly person just doesn't get enough to eat. Sometimes she's too depressed to face food or loses interest in cooking proper meals. Other times she's too tired to bother. Or perhaps she can't afford more than a limi ted range of convenience foods. And the result: undernourishment. Wi ut v proper food she can't qe bothered to get things done. She can't sleep properly at night. She feels despondent and low. And before she knows it she's in the Downward Spiral. You can help by recommending 'Complan. Complan is a milk balanced food tHat's just right for an elderly personit's easy to mak'e, tasty and very gentle on delic'ate digestions. It'contains all the and minerals tlo give her the nourishment sile needs. I I Complan is good value too - one cup;takes the place of a light meal of 250 caloriesyet costs only about 5p.

AMERRY CHRISTMAS to all Review readers

JOHN REVIEW

AT RANDOM

by

MRS A E EVERARD (Principal Superintendent (N) and Executiv e Offi c er for St. John Ambulance in Kenya) was on the tarmac in uniform to greet me at Tairobi airport. She piloted me through ell tom and immigration and gave me the late t revised copy of my fortnight's programme. It looked rather daunting at fir t , but I was relieved to find two days labelled FREE; when they arrived, I spent them in a tate of llspended ;lI1imation, recovering from what had gone before I wa ba ed at the home of friend with whom I had tayed on former visits, the Revd. and Mrs. Peter Davie of :\airobi School. But if my programme was so full that I had too little time to be with my ho ts and their family, I had no one but myself to blame: for when the Commi ' ioner (Sir Charle Markham) a ked me what I hould Iike to ee in Kenya. I had replied that I hould particularly like to visit the isolated outposts of St. John as well as seeing something of work in the big cities. So at 8.30 a.m. on the morning after my arrival Mr. James Fa tel' (Deputy Commi '. ioner) took me off in hi car for a 6-day afari through the Central, We tern and Provinces , during which time we travelled 1,000 miles on all sorts of road in all sorts of weather, at height ranging between 5,000 and 9,000 feet. and ero sed the equator six time'>.

Animals

Our wa at 1urang'a, where we were met bv the A sistant Commt · ioner of Police for the P;'ovtllce, who escorted us for the rest of that day and of the next. I visited the cathedral and photographed the very beautiful mural ' of the Life or CIUt ' t, painted by an African arti , t ' orne 15 year ago_ Then we went to the Police HQ where I met 1 members of the t-.lurang\l Police Division: from th re we went to the Police College at Kiganjo. where an A ' ociation cl,] s of ju t ove r 100 trainee policemen W,] being examined by -+ doctors and ) I,]), lecturers.

After lunch in the me ' with Mr. Hewson (Commandant), w were round the college llnd it was casy for me to sec why thL' Kenya Police Lire slIch (Col1filllled 011 I } ())

Watkin W. Williams Deputy Commissioner -in-Chief

After the Service the marc h past

Subject Publicity

PUBLI C IT Y an a ll-important subject for a movement such as ours was the theme of the 1973 Presidents' and V ice- P residents' Conference hel d in L on d o n o n Saturday, O ctober 20 at the R oyal Co ll ege of Surgeons, un d er the chairma n ship of Marjorie, Countess of Brecknock, the Chief P resident.

Nearly 300 delegates compnsll1g Pre idents, Deputy PreSidents and Vice Presidents of counties, districts, centres, div l sions, areas and corps, from all parts of england as well as representatives from Wa les and '-ior t hern I rei:.lJ1d were present.

ORDER SERVICE

the previous olle had becn destroyed during World War 2, i· alongside the remaining 1 1th-century orman buildings.

After the service the address was given by the Assistant Bihor of Coventry, the R Rev. J D. MacKie, who is a member of the S1. J ohn Council and a S ub- P re l a t e of the O rder the S1 t\. m e m bers marched past the aluting base at h e foot of the Cathedra l steps.

D uring the morning the conference was addressed by two di. tinguished guest speakers, Mrs. Archie Parker, the Diary

Edito r of thc Tatler magazine and M r. H uw T homas, the well-known televlsion broadcaster and public relations expert.

Both discussed in a practical and down to earth way the importance of publicity to S1. John JJ1 connection with fund raising, recruitment and morale and how such publicity could best be obtained through the press, radio and TV.

The measure of the gue t peakers' success in stImulating their audience was t he brisk demand for the roving microphones by delegates anxious to ask penetr<.Jting que tion

After the buffet lunch. short talk on various aspect. of the work and progre s of S1. J ohn were given by Lady Moyra Browne, Superintendent-in -Chief: General D. S. Gordon, the newly appointed Commlssloner-in-Chief; Mr. F. Marsh, D irector Gcneral: and Sir H ilton Poyn t on, D ircctor Overseas.

G ene a D. S Gordon, C om m iss Ion e InC h I ef, addresSing the conference

Dlarv editor of the Tatler magazine, Mrs A r chie Parker. was a guest speaker. (L to R) M N F Marsh, Director General of the ASSOCiation, Sq Ldr G. Meek, Director of P ublic Rel<:ltlons, MarJorie, C ountess of Brecknock; Mr H uw Thomas; L ady Moyra Browne, Supt In Chief; and Gen. D S Gordon, C In C

An open forum followed during which ma n y stimulating questions fro m the del egates were answered.

I n addition to attending this conference, 25 county PRO s were invite d on the following Sunday morning to G rosvenor Crescent for a public relations symposium at which the principal speakers were Mr. Ian Yfac P hail, a Fellow of the I nstitute of P ublic R elations, and Sq - Ldr. Geoffrey E. Meek. St. J ohn D irector of P ublic R elations and Fun d R aising. T hey were joined later at a Q uestions Forum by Mr. Walter H oadley, PR Adviser to London D istrict. and by Mr. J ohn H. Lockett, PRO to the O rde r of St. J ohn.

Many of the PRO s expre sed their appreciation of what they con idered to be a useful and worthwhile exerci e which they hoped would become an annual e\oent.

Prison camp surgery

Robert Harvey, MBE, MB, ChB, FRCS Ed.

HOW DOES one start a hospital with no nurses and with no hope of getting any?

The sensible answer is that you don't , unless you consider yourself in the Albert Schweitzer class, and even he had the odd nurse around. But it can happen and it did to me early in 1942, when the Germans ordered me as a prisoner-of-war doctor to start a hospital in one of their prison camps in North Germany.

There was a small surgery in the camp and four doctors from various countries all except one quite unsuitable, through illness or age, to do serious work.

The Germans allowed me to recruit ten good doctors from various camps, but what about nurses? We had about 7,000 prisoners in the camp itself and were expected to treat internees, and other prisoners-of-war, a wide area around in our hospital, which was to have about 150 beds for acute cases.

By the Grace of God, and the accuracy of the German gunners, we had about 200 ships' stewards from ships sunk all over the world. I decided that our nursing staff should be recruited from them.

After all, they knew about looking after people, keeping rooms clean, serving food, being careful about their appearance - not a bad starting point.

There was no lack of volun teers. Work to a prisoner-of-war was a privilege and work in the hospital gave promise of slightly better conditions than in the ordinary camp barracks And so training began, not I fear a training scheme that Prisoners exercise in a snow·covered compound

An Army surgeon captured during the last war was ordered by the Germans to create a hospital in a prison camp. He describes the ruses which kept the hospital working and how penicillin gatecrashed Europe

would be approved by the General Nursing Council, but one force d on u s by the necessities of the moment.

There were sessions to teach medi ca l terms, a completely new language to all the trainees; lesson s in hygien e and sterility, quite the hardest lesson for them to apply; lessons in the taking of temperature, pulse and respiration rates, simple clinical observations, things to report and note , the names of surgical instruments , types of ligatur es, needles, and so on. And again and again lessons in sterile technique in the operating theatre.

This was very difficult to achieve, mainly because the camp's buildings were wooden huts, and sepsis was a consta nt menace. We were not badly off for instruments, gloves and ligatures almost entirely because of a large supply of coffee which we secured from Brazil. The Germans were very susceptible to supplies of good coffee, and operating gloves, a naesthetic and surgical instruments appeared in return for a very s mall outlay of the precious bean. Al so, the prisoners were very ingenious at making things, and a faradic machine , splints of all sorts, and other aids were all miraculously produced.

A great friend was 'Smelly Nelly'. This was a long m e tal cylinder OIl four wheels, used for the unpleasant job of pumping out the septic tanks The bright boys managed to seal off the front quarter of the machine , and this space was us e d to bring into the camp various items

lib erate d ' by them during their Smelly Nelly visits to farms and other places. Chicken, pigs and vegetables, wireless sets, tools, booze, maps and work passes for foreign workers a ll came safely into the ca mp chaperoned by old Nelly! The foodstuffs were very useful In the hospital, and orne very ill patient got luxuries that they would never have seen otherwise.

The work of the hospital grew rapidly, and the 'nurse' became more and more interested and skilful in looking after their patients. Every morning the general duty doctors visited the barracks, sent us out-patients and sorted out the minor problems, while the surgeons, physicians and the pathologist got on with the hospital cases.

All the cases usually seen in general ho spitals appeared: pneumonias, asthmas, coronaries, anaemias, appendices, perforations, fractures, gall-bladders. In addition, we treated patients with old neglected war wounds, 150 nerve injuries a m o ng them, new wounds and malnutrition. There was an outbreak of hepatitis, of polio, and most feared of all typhus. Diph theria also wa not unco mmon , a nd TB constantly cropped up. Mental cases were a difficult problem and we had a specia l annexe for them. It is interesting that our mental expert (he refused to be called a psychiatrist) found in everyone who wen t 'round the bend a history of mental instability before hi prisoner-of-war days. Not one prisoner

who had been mentally stab le before had cracked up during cap tivity . I n rna n y cases th e pa tien t's first symptom was an excessive obsession with religion, caused, 1 suppose, by a feeling of helplessness and the failure of his contacts with his fellow prisoners.

Another problem was, 01 all things, alcoholic pOisoning, The bright boys, in addition to their other cargoes, smuggled into the camp copper piping, yeast, barley and other raw materials for its distilling industry. Unfortunately the moonshiners were pretty impatient to sample their products, and produced alcohol at far too high a temperature, so that higher alcohols came over during distilling which proved to be very poisonous.

They produced a condition known as the 'Black Despair' which, like sea sickness, made you afraid you were going to die on the first day, and afraid that you were not on the second! More seriously it produced optic atrophy , and we had two ca es of blindness which proved permunent.

I therefore had to go into the distilling busine<;s and try to produce something less dangerous This we did by di tilling slowly at 70 % storing the stuff underground and skimming off the top on two or three occasions It wa till pretty raw, but at least the optic nerve stood up to it.

Our old friend Smelly elly was also re ponsibk for saving the life of an RAF prisoner. Being a new boy and not knowing the etiquette of busine s trading, he tried to bargain for some eggs acro s the perimeter wire, and wa shot for his pains The bullet went through his nght kidney, through a vertebral body without damaging the spinal cord, and ploughed into hiS left lung, causing collap e of the lung, und haemopneumothorax. 1 removed his shattered kidney; drained his left thorax and removed the bullet. H e recovered from the operation, but there was gross infection which wa , likely to be fatal

Some weeks before this, however , Smelly elly had come into the camp with a wirele et in her anterior cham her. We had ma naged to keep the set hidden and a great comfort it was. One night, li stening in, I heard news of a new wonder drug. This I rather shrugged off because I wa much more interested i n the war news, but the next night it was mentioned again, with a detuded account of how revolutionary it was. The drug, of co ur se, was penicilllll.

I decided to get a supply sen t , but how was I to do this without the Germnn finding out that I knew about it? Luckily, an American internee who was being repatriated came t o o ur ho pital to have hi shattered e lb ow Join t at tended to. We put o n a new plaster and in it hid a lette r to the Briti h R ed Cros asking for a s upply of penicillin.

It arnved by air via Sweden in the nick of time and the airman, the first person in Europe to be treated with penicillin, made a good recovery.

Escaping or attempting to escape played a big part in the lives of the prisoner. I felt that the efforts made in preparing to get out were excellent therapy for boredom and inactivity. We organized an escape committee and all potential escapers were vetted on their plans, their ability to speak at lea st orne German, the disguise they had prepared and food they had managed to save. If they passed thi test they were helped in every way.

[t wa not too difficult to get chap away, especia lly from the working camp outside the main camp, but travelling acro s Germany was very difficult. The e caping ea on la ted from May until O ctober, an d in one sea on 147 men got out of whom four got home ot a very high average, but a very helpful, if dangerous, form of entertainment.

My own captivity lasted fOllr year exactly, most of the time spen t in building up the hospital and a very useful four year they were. I learned the value of simplicity in surgery, the importance of making it easy, and I think that I emerged a better doctor than when I went in J was constantly a tounded at the humour, ingenuity and kindnes of my fellow prisoners. There were mi. fit :.md

grumblers of course, but the vast majority responded to the challenge extre mely well.

What of 'our nurses? A small triumph for Men's Lib perhaps? It 's a little incongruous to talk of Men's Lib a mong captive men, but they were very good and some trained as male nurses after the war. One became a doctor, and one a pathology la boratory su perin tenden 1. In the camp hospital most of them worked long hours with no reward , financial or otherwise, and they enjoyed it. They were indi pensible to the mental patient and did all sorts of job which really had very little to do with nursing. O ne of the few who lapsed tole 100 bed heet to make football shorts for the various team in the camp. Hi s excuse was that they were German sheets and therefore could be liberated!

Should men therefore replace women as nurse, having shown so many virtue when called on? If you want my humble opinion I till prefer the girl.

(Reprinted from Nursing Tillles)

Mr Harvey was a major in the Army and surgeon -specialist to the 26th General Hospital when he was captured in Greece He retired this year as Senior Surgeon at Cheltenham General Hospital

Another operation completed in the camp operating theatre

DEREK FENTON MBE

At Bu ckingham Palace on Octob e r 31

D erek Fenton receiv e d the MB E f or services giv e n to London s St J ohn

A mb ul ance particu larly in conn ec ti o n wit h the resettlement of th e Uganda Asians.

Mr. Fenton is of course, a Deputy Com m issioner of London (Prince of Wa l es ' ) District , on e of the f e w of that rank in S1. J ohn who has been through all t he ranks since joining as a cadet in 1 9 37

The many major ev e nts for which he h as organised the first aid arrange men s h ave induded Stat e funerals (Sir Win s ton Churchi ll ) , roya l w e ddings ( Princ e ss Margaret and Prin ce ss Al e x a ndra ), a nd variou s political demons t r a ti o ns o ve r recent years. Hi s mo s t recent fi rs t a id assign m ent i s P r in c ess Anne 's w e dding

WAR

The following wa s r eceived fr o m Dr. B atten the Warden o f th e Ophthalmic H ospital in J erus a lem during the rec ent Ara b -Israel c

T

' P rices of some commoditi es have already risen in practice although som e price c ontro ls apply in theory

I have been unwillIng o authorise mu ch expenditure on blacking out th e h ospita l, but as enfor ce men t of the bla c k o u is getting stricter an d there s e ems n o sig n of the authoriti es lifting it , I h a ve no w arrang ed to purcha s e some e x t r a bl ack out materials With the vast am o unt of wi nd ows we h a ve with o ut shutt e rs of any kind, this i s quite a p roblem.

'No mail other th a n that whi c h was in the country at the s tart of the war h a s s o far b een received , but we believe m a il is

AROUND and ABOUT

WHAT ' S GOING ON IN THE WORLD OF ST . JOHN

BY THE EDITOR

APPOI NTMENTS

HQ : Prof. H S S te w art to D.D G

Dr. A Rafn e to C. M O Mr. Mah e d e va o C h ief A cco un ta n t.

Bu ck: Co l. Gord on ap p ointed

Ch a i r m a n St J o hn Co u ncil.

West R iding : Lt Co l. R D enby to D e pu ty Co mmi ss io n er.

Do minica: Mr. E.

Ugand a : Mr. Lu ke K I dro to D ep.

C o m

Sa b ah: R aj a h I ndr an M to D ep.

C om

S ri L a n ka: Dr. F O F erna nd o to D e p Com

getting o ut a lrigh t. Cab l es are now r estri c t e d to 7 w o rd s. O h e r in s t itutio n s 1

h ave spoken wit h have a lso had no m ail.

An yth in g i m porta n t o n w hic h yOLl wish m e to ac t , pl ease cab e.

0 b a n k tran fer ha d bee n received at t h e time of writing, an d our account m ay soo n run nto overdraf par t icular l y as there has been the expe n ses of the replaceme n t of leaking pipes in the kitchen corri d or.

'I n brief, we are st ill in a phase where o ur pro bl e m s arc adm In strative rather t h an med ica l. This means tha t the nLlrsing s t aff bo th loca l a n d expatriate are und eremploye d a n d althoug h certain spring c l ean i ng' type Jobs are b e i ng done, these u nglamourous tasks in a i me of tens i on are not a l ways app r eciate d !'

GO -GETTERS

As soon as L on d on's o. 220 (Walworth) Amb u l ance D ivision dedicated it 11l.'W £3,0 00 ambu lance last sum m er, the D ivision se t itself another fund-raising target £20,0 0 0 for a new HQ 15 years' hence.

Bu t back to the ambu lance. A year ago he D iv ision carried out a feasibility study as to whether t hey n eeded an a m bulance.

This resu l te d in showing u great need in the urea for wheelchair transport , as loca l counci l fuci l ities, limited to working withIn borough boundaries, were Inadequate for the dlsubled clubs. Aho many local disabled people, who were bcd-ridden, had not been outside their front doors for YCdrs

So the DIVIsion deCided an ambulance a new one was needed, especially .IS the Borough SocI,lI Services Department and the Multiple Sclerosis Committee offered them as m,ln) ddvance bookings for oullngs .I nd removah as the) reqUired.

The ambulance fund '>tarted in 1970 with weeki) BIngo, which sttll contInues, WJS now up to fever pItch, \'vith Jumble ddnces, appeal'i to traders, football L'ompctltlons, etc.

The vehIcle chosen WdS a Bedford CF25cwt van converted by Wudham tringers to an dmbuL.lnce WIth 2 single berth trolky", WIth slele armrests and bdckre-.ts fitled to take ( sIttIng patIents plus the By the nIck of a handle the trolle) S Cdn be removcd to give floor "pace for 4 \'v heckhJir-;, floor Llnchored, LInd one stretcher tmlk): WIth man) other v,trlatlons. DrIp bottk rails JIT roof-fllted and there IS o\ygen cylInder spaL'L'.

After 'ii x mont hs' of real hard graft fund-rai-,lIlg, lhe new W,IS delivered to the DIviSIon dnd dedIcated

la t July; it went into service immediately (See photo above).

INFOR M AT I ON

The attentIon of all training officers inVIted to the Briti h Medica l Association pub li cation Info r mation', a bi-monthly bu lIetin (£,1.00 per annum) which contaIns Items of interest to all medIcal teuchers and S1. J ohn trail1Jng officers.

Specimen copIes are obtainable from: Department of Audio V i ual Communication, B. M. A. H ouse, Tavistock Square, L ondon, WCI H 9 JP

TYRE TEST

Womens' LIb IS nothing new to the S tot fold CombIned Division, Herts, especially when their ambulance is suppo ed to have a nat tyre.

My photograph how three members Tran port Officer R odney SJunderson, Divi<;ional Officer l is Jacqueline Burrows, and ursing Member Mrs. Margaret Lavery changi ng a wheel as one of the tests in the ambulance and crew efficiency competition run by the northern area of H ert S J A.

The competition, a new one

the northern area, orginally attracte

ent

ies from several divisions. Unfortunate ly on the day only Stotfold an d Steven a ge orthern were availab e to compete. Th e Area Co mm issioner, Mr P hilip P laye r , is sure h owever that things will be differe n t next year, with all divisions w

REFLECTIONS

Yes - that one looks pretty good, Trying to keep up with fashion in these hard times at No r wich. See SHOP! P h oto: Eastern Daily Pr ess)

OSMONDITIS

This is not a new diseas e - bul a manifesta tion of the old hys terical hero-worship, this time in the world of pop music.

It showed itself on October 26 when 201 cases were treated by St. John members who sent 14 of them to hospital - mostly suspected fractures, four having been knocked down by cars.

The 52 St. John people on duty from London District were mostly drawn from divisions local to the Rainbow Theatre in Finsbury Park , where some 5,000 fans had gathered to pay homage to their idols the Osmonds. Unlike some gatherings of this nature most of the fans were 'tweenyboppers', between the ages of 8 and I 5, some having travelled from as far away as Jarrow and Port s mouth.

The 35 ambulance and 17 nursing members started the duty at 2.30 pm and finished at 11.30 pm, with the support of 3 ambulances and a mobile unit from Weybridge and the closest co-operation from the London Ambulance Service.

London Deputy Commissioner Derek Fenton, MBE, who was in charge of the operation, said he 'was amazed that these very young people , from 8 years old, had been allowed to travel alone so far from their homes'. He was assisted by D/Supt. A. W. P hillips, of the Northern Heights Combined Division.

SHOP!

The SJ A Thrift Shop in Norwich has now been open every Tuesday for five months , during which £800 has been taken The clothes brought in are all carefully vetted and have to be clean; many of them are virtually new. They are sold on a 50-50 basis. a half to the customer and a half to St. John.

The shop is a room kindly lent by Mrs R i dIe y - Thomas , the Norwich Area P r esident eN), and it is manned by a team 8

(Right) Retired D. O. Mrs. Codd handing over an invalid chai r to E ast Riding Commissioner H M. Gentry. See GI FTS of volunteers who d o one Tue sday a month on duty.

It is hoped , with the enormous increase in the price of clothes, that thi shop will be a mon ey -spinner for St. J ohn all the year round. (See photo above).

GIFTS

Yorks' East Riding Commissioner H M. Gentry and members of the counly staff recently visited SJA Horn sea (combined and the cadet division) for their annual inspection and two unusual presentations. First , Horn sca cadets were given a canoe for seamanship training by the Low Skirlington Sailing Clu b for services rendered to the sailors by the division. And second, the Horns ea Divisions were presented with an invalid chair by local resident Mr s. D. Codd, who was D.

O of the Hull Haworth ursing Division for many years. The chair IS to be us ed for taking e lderl y, infirm or sick people to the sea-front at HornsL'a, which is popular East Y orkshire holiday re ort.

MB E

Mr. Thomas Hope SR (Area Superintendent (A) of the South Durham Area) was awarded the MBE in the Queen's Birthday H onours ltst tJllS year for his services as Theatre Superintendent, Ryhope General H ospital, Co. Durham.

Since the a ward had no direct connection with his work for St. J ohn Ambulance it has only JLlst come to our notlce, but we would like to offer him our belated congratulation.

AT RANDOM (continued from page 1)

a fine body of men, with a high standar d of efficiency both as policemen and as firsl-aiders. From Kiganjo we drove on to spend the night at Mountain Lodge, a tim ber-built hotel 'on stilts' near a floodlit drinking pool in the Mount K enya National Park Lo t s of animals visited th e pool during the hours of we saw many kinds of buck and graceful gazelles, buffaloes, bush pigs and a herd of at least 24 elephants (including babies).

But t hey were all except some of the buck, who seemed quite unperturbed kept away from the pool for nearly J Y2 hours by a couple of rhinos, knee-deep in the water, haVing a fencing-match they thrust and parried, feinted anc! charged, and every few minutes they withdrew as if some llwislble timekeeper had rung a bell for the end of lhe rOllnd At IJst one of them (the larger) got pin ked on the jaW and deCIded he had had enough, so he backed away to a respectable distance, lay on IllS back and had a good roll in the grass, and then tl undkd off Into the forest. The victor made no attempt to pursue his advantJge, but stood In the pool and snorted to proclaim hiS triumph. Only when he too had gone away did the dephLlnts, \\ 110 had been standing in a rov. Wit h thel r bLICks to t he scene as tf pretending not to notice (Just like a picture in one of the Babar books), turn round and come to the pool to drink B-P

The next tiLlY, which WJ'-, Sunday, we drove to \Jyen and were met at the Outspan H otel by the AssL Commissioner of P olice, the Sl. John Area Superintendent and the District Scout Commissioner, who took u to visit Pa xtu, the last home of the first Lord Bad en- P owell of Gilwell and now a museum.

Welfare Cup competition

We want your ideas, in an essay, on the best way to award a Welfar e Cup on a national basis:

1. Entries (max 2000 words) to be divided into two ca tegorie s:

a) Aged 16 years or over on I-cbruary I 1974.

b) Under 16 years on January 31 1974

2. Essays to be typed or written legibly (one side of paper only), and sent to: The Chief Nursing Offi ce r, St. John Ambulance Brigade, J, Grosvenor Crescent , London , SW1X 7EF by January 31 1974.

muddy water s wooshed up con tinuou s ly over the windscreen. By the time that we reach ed Keri cho the evening sun was shining on the bright green of the tea fields that stre ched in every .direction, an d we put up for the nigh at t he Brooke Bonds Tea Hot e l. Hospitals

We went on next day to Ki su mu , on the shores of Lake Vi ctoria yanza, where we met various St. John officers in the morning, and in the afternoon went to a May oral reception, followed by an inspection of about 80-90 members (A and ) of the l oca l Po li ce, Fire Brigade and R ailwuy Divi sions and some 40 cadets of the newly-formed Ki su mu Youth Centre Combined Cadet Divi ion. [ then presented a large number of medallions and other awar d s, and was delighted to find that the first of those who came up to receive their medalltons was the Ass!. Commissioner of Polic e for yanza Pr ovince. Finally they put on a most entertall1ing programme of displays, the N/Ms performing action-songs in tribal dre s, a nd the m en a series of ketches involving first aid.

We dined with the chairman and secretary of the Kisumu Rotary Club, and set off next mornlng for Busia, 100 mile away in the Western Province, where we were met by Mr. Kang 'ara (Police Supt. and a very keen lay lecturer) and Mr. Ond e (acting Area Supt.).

for the night by the Area Chairman, Mrs. Richardson

Th e final day of the safari included two inspections of P olice, Fir e Brigade and Railway Divis ions at Eldoret and Nakuru. At the former 1 had (for the first and probably the last ti me in my life) the honour of being 'gar landed by a smashing Afri can W.P .C! Mo m b asa

]n the seco nd week I attended a meeting of the St. John Council for K enya and a luncheon party to meet Council member s an d Brigade officers in the Nairobi Area, and spent a day at the airobi Agricultural Show where I visited and inspected the splendidly organised first aid posts.

But the mo st outstanding event was a weekend trip to Mombasa (300 miles by road each way). The generous warmth of my welcome at Mombasa was second to none in all my Afri can tour. In a temperature of 93° F I took an Area In spectio n (held at 9.30am 'because It would be hot later') with about 400 on parade from 9 adult and 9 Cadet Divi sions. Only one member fainted on parade, and the cadets even had the energy to put on a most entertaining display afterwards.

4. En tri es in catego ry (b) to give th e wriler\ date of birth. Those which do not give thi s 111formntion will be tr ea ted as ca tego r y (a).

5. In judging th e essays, cred it will be given to ideas on the lln d only in the event of a tic will th e quality of th e essay i [scI f be taken in [0 aCCOllnt.

6. There will be a prize of £5 for lhe besl in each ca tegor y. A econd prize mllY be awarded in either or both ca tego ri es if the of entries warrants it.

3. Entries to have the word Welfare' written on the top left-hand co rner of the envelope, and must be accompanied by the writer's name (Mr, Mrs, or ;Vli ss), Brigade rank and unit ( Divi s ion, Corps, Area, etc.) or other connection (cg Pre s id ent, Auxilinry).

Among my treasured po sessions are some of B-P's ketches of yeri that he sent as hiS peronal Christmas cards, and a letter that he wrote me from Paxtu a few months bl.'fore he died I never dreamt that I sho uld some day V1SIt the house where that l et ter was wrllten

At the Po li ce HQ we met and talked to members of the yeri Poli ce and 'open' Brigad e Divisions, and then drove to the Anglican cemetery to visit 8 -P 's grave, where I was deeply moved by the cout Commissioner (a turbaned Sikh) inviting me to say a prayer.

After a hot s unn y morning, the heav en opened while we were haVing lun c h at the hotel and a tropical storm des ce nded and lasted for a bout three hours. We set 01'1' on a 4-hour drive to Keric h o, much of it In torrential rain and along dirt-road from which brown

During the course of that day we called on two local government official (the Di strict Officer at Bu sia and the acting District Commi<;sioner at Bungoma), and visited three hospital (the Leprosy Ho 'pltal at Alupe , Bungoma H o pital and St. Mary's H o pital Mumia , at all of which first aid trainmg was in one way or Jnother belJ1g prOVided for the trainee nurses and/or the local community), and Brigade m e mber at three Polic e HQ including a frontier post on the main road to Uganda Garlanded

The following day we visited a girls' schoo l at Mukumu where a me mber of th e taff hoped to start cadets, members of the Police Divi sion at Kakamega (where we also cal led on Pol ice and government officia ls)' an A/C Divisi on at a Borslal In titute at Shikusa, and an extremely keen N/C Divi sion at the Ligulu Girls' chool at Webuye, where th e cadets demonstrated bed making and gave a most entertaining display of bathing and bottle-feeding a (celluloid) baby!

We se t off again through squelchy mud (delayed by a s kidded bus that blocked the road from bank to bank) for Kit a le, where we met the adult Combined DiviSion and were hospitably entertained

In the afternoon I bathed in the sea (temp. 89°F) , and that evening attended an informal d inner for officers, member and families of the Brigade_ On the way back to Nairobi I inspected the Railway DIvi sion at VoL a little town 'a hundred miles from anywhere'.

So K enya nobly responded to my reque t to ee the splendid work being done by St. John members in the little out-of-the-way places as well as the big cities, and from my point of view every moment of it wa tremendou ly worth while.

Home ine day ' after my retu rn home I had the inspiring experience of attending the Service of the Order in Coventry Cathedral. One of its most enduring memorie will surely be that of the tory told by the Rt. Revd J D McKie , As istant Bi hop of Coventry, in his address.

A rich and worldly w oman wa being taken round Pari a century ago, and met a nurse who was working with devoted care in the terrible slum that prevailed at that time. The woman \Va much impre ed by the plendid pirit of the nur e in uch appalling conditions and sa id to her: 'I wouldn't do what you are doing for ten thousand a year'. 0, replied the nur e, 'neither would 1.' And with that example of Christ-like compassion 111 our minds, I wi h you all the JOys and bles ing of Christmas.

9

Recognising Shock PART TWO

ONCE SEEN , IT IS UN LI KE L Y TO BE FORGOTTEN

IN THE OVEMBER Review , I explained the clinical condition called P rimary Shock. The arterial side of the cardiovascular system was represented as an elastic reservoir of blood into which with each stroke, the heart pumped blood. The elastic reservoir of blood was kept at a fairly constant pressure in order that blood could be driven from it through the arterioles (or 'taps') to aU the organs of the body Obviously, a pressure was necessary if blood was to flow. L ater it was stated that the brain blood supply

was the most important and that this a lways took priority. Th e heart muscle blood supply (t hrough the coronary arteries) was also given priority in order to e nsure that the pump cou ld continue to fun ct ion ; all other orga ns cou ld if necessary have their blood supp ly closed down in order to e nsur e that available resources co uld be dire cted toward the brain and central n e rvou s syste m It w as seen that a special part of the nervous system, the sympathetic nervous system, controlled the arterioles; it

by R _ A . Elson , MB, FRCS

Secondary Shock ensues from Prim ary Shock; clea rl y, this clinica l cond iti on is becoming right outside t h e managem ent of a firshllLler but while good first aid and efficient transport may not be able to prevent shock following an injury, it c ln bring the patient to necessary medical aid where it can be corrected. The delay or aggravation of the P flmary Shock because of ineffective first aid may lead to development of a much more serioLls state or Secondary Shod..

SecondLlry Shock, unlike Primary Shock, docs not show ready improvement In the clinical situation when a blood transfusion is given and haemorrhage has been stopped. The reason for this Wei" not understood for many years but it is now l-.nown to be a highly complex problem. Man} of the features are ill-understood although we haw mudc a lot of progress in the correction of Secondary Shock.

operated a ll the time at a et level of ac tivity but in the event of a lowering of the blood pressure due, for example, to haemorrhage, increased activity of the sympathetic nervous system would be brought about. A well as closing clown a ll the ar teri o l es s uppl ying blood to the le ss necessary organs for survival, the sympathetic nervous system causes side effects lik e sweatll1g, pallor and enlargement of the pupils of the eyes. These signs come on progrcs lvely as bleeding continues and they constitute the syndrome of Prim ary Shoch..

Early in the article I indicuted that Prim ary Shock could be corrected easily by fluid or blood replacement (u transfusion) but that should ccondary shock ensue, the situation became much more resistant to any treatment and special measures beca me necessary. or m ally, in a patient who is in a state of Prim ary Shock, as oon as a blood transfusion is commenced and any bleeding arrested, the pulse and blood pressure (and other signs of heightened sympathetic nervous activity) correct progressively. Subsequently the body co mm ences repair activilie 0 that any damaged tissues are replaced and wounds are healed. The repair mechanisms necessitate the breakdown of the body's proteins in order to provide the necessary s ubstances for th e n ew tissues which will bridge the gaps created by wounds or replace damaged or dead material. Usually the patient l oses weight bu t over a period of months in a normal healthy individual all this deficiency s lowly corrects.

This seq uenc e of events is seen after serious illne ss or after an operatio n both of wh ic h types of condition ca u se some degree of tissue d a mag e which has to be replaced or repaired. Th e nece sity for a patient to convalesce after a sig ni ficant operation or illness is well known.

In this article I will try to explain how

increased during exercise. The muscles con tract using oxygen and glucose and liberating carbon dioxide; the l atter acts on the local arterioles causing them to dilate allowing more of the available blood from the great elastic arteriole reservoir to he diverted to the active muscle.

Now in the state of Prim ary Shock, t he sympathetic nervous system is keeping all arterioles closed and they become less sensitive to the effect of carbon dioxide and other acidic substances locally. Despite the accumulation of these substances the arteriole do not open up and the cells remain deprived of oxygen and glucose and In addition they become poisoned by the accumulation of chemic Jls which are normally washed away from them by an efCective blood stream.

The IInportant Clllses of the progression of P rimary to Secondary Shock are, flrstl}, liberation of poisonous sub s tan c e s Ir 0 m dam age d cell s throughout t he bod} due to their haVing been depflved of u blood supply and, secondly, the exhuustion of the blood clotting mech,lnlsms. I must explLJin these.

Whenever the cells 01 the bocly ure deprived of theil blood they lack ox) gen und glucose; carbon dioxide Jnd vurious Jcidic substances uccumulate : these are abnormal waste products and because there IS no blood flow, the) cannot escape Normully the budd-up of the carbon dioxide Lind uCldic sub tances is responsiblL' for opening the local artefloles and, for example, thIS IS how the blood suppl) to the muscle" IS

P rOVided the muscles are not contracting vigorously (as will probably be the case in a patient with Pr imary Shock) they can exist in this almost bloodless state for a time , but after an hour or so the build-up of the acidic substunces is so great that, despite the action of the sympathetic nervous <;ystem, they even tually succeed in puralysing the arteriole so that the latter dilate and allow some blood flow to occur; thi will undo some of the mechanisms of Prim ary Shock and sorely needed blood is allowed to escape from the greut elastiC artenal re ervoir which the Pnm ary Shock mechanim are trying to direct to the bruin and heart muscle exclusively.

At the same time the acidic substances which <lre poisonoLls, escape from the muscles into the veins returning thence to

WEST COUNTRY WING

The only SI. John Air Wing pilot operating from Devon and Cornwall is 52 year old former RAF pilot Ron Wingfield of St. Austell. FIYII'g out of Bodmln airfie ld which was recently reprieved from a threatened c lo sure, Mr. Wingfield has recently made two Wing flights, to Northern Ireland and Newcastle In ti,e photograpll he is picking up a kidney at Plym outh bound for Newcastle Ph oto: West of England Newspapers)

the heart and then being pumped out through the lungs to all the other tissues again. There is a build-up of acidic substances which quickly exhausts the blood-stream's power to neutralise them and once this has happened the whole body becomes progressively affected by increased acid content; these acidic substances are poisonous. They produce profound effects in the lungs and kidneys and soon will depress the heart itself. They are likely to produce alterations in the blood's ability to carry oxygen and this function will quick ly affect the brain. It is not only simple acidic substances which escape from the poisoned cells. When cells are deprived of their blood supply for a significant period chemical changes occur inside so that many chemicals are produced. Some of these will produce local thrombosis (clotting of the b l ood) in the smaller blood vessels and others when they escape into the main bloodstream, as did the carbon dioxide and acidic substances, will reach the lungs and produce clotting here. This unwanted clotting process clogs important blood vessels and helps to exhaust the supply of special substances in the blood which cause the clotting to occur at all. Thus the disturbance of blood clotting in this way, on the one hand blocks the blood supply to organs such as the lung, gut or liver, and on the other hand uses up the e sential factors for clotting so that wounds begin to bleed again. Thereafter progressive bleeding from the site of the wound can continue despite blood transfusion.

Blood tran fusion is a life aving gift which we have only been able to use for relatively few years. Due to the torage of Tum ol'erleaf

Recognising Shock (Contd')

the blood man y of the clotting factors can become gradually reduced in amount. In some cases of Secondary Shock the best treatment is to give fresh blood which, of course, is much more difficult to obtain.

There is another feature of Secondary Shock, of a more prolonged nature, which is due to interruption of the blood supply to the kidneys as a result of the closedown of the local arterioles of these organs; the little tubes which collect urine as it is formed can become seriously damaged and even if the blood supply is corrected this damage may lead to shutdown in the flow of urin e. The patient is said to become anuric. This condition used often to be fatal and it is a great medical advance which enables us to put such patients onto so me form of artificial kidney thereby prolonging their life.

The tubular damage to the kidneys often slowly corrects and while kidney recovery is awaited, the kidney machine prevents accumulation of poisonous substances in the bloodstream. Other organs which may be seriously affected at an early stage by the temporary shut down of the blood supply in primary shock are the liver and the gut wall; the bowel can dev elop ulcers and if the liver fails, there is very little chance of recovery.

Finally , one shou ld know the effect of damage from temporary los of blood supply to the adrenal glands. Jt will be remembered that these organs which lie ju t above the kidneys secrete adrenalin into the bloodstream and that the latter was one of the chemical me sengers or hormones helping to reinforce the effect of the sympathetic nervous system. The adrenalin glands also secrete other hormones which are vital to the maintenance of many aspects of body function. These hormones are like cortisone and in a variety of ways support the whole of the chemical processes which go on in the body. If the cell which produce these vital hormone are damaged as a result of loss of blood supp ly the patient rapidly goes into a state of comp lete collapse.

Thus Secondary Shock stems from the damage of cells affected by a temporary but prolonged loss of blood supply. This is due to the state of Prim ary Shock which is necessary to keep the blood supply to the brain intact during a period of reduced blood volume, usually from haemorrhage. Secondary Shock used to be grave, usually fatal, but now we are able to correct a variety of the causes.

For example, the failure of cortisone secretion can be corrected by giving cortisone injections; the failure of blood clotting can be remedied by giving fresh blood or by injections of specific clotting factors. D eath from kidney failure, often temporary, can be prevented by putting the patient temporarily onto an artificial kidney. Multiple clotting throughout the body due to the liber ation of toxic substances from cells such as muscle or liver, presents a more difficult problem,

Preparing for Shock ..

.

before I tell you the price, dear, there's something I want to check in my First A id Manual

but we believe that in the future certain drugs will be available which may be beneficial even in this n ;s pecl. The intense acidity of the blood which can develop can be corrected by injecting alkaline su bsta nces with the blood transfu ion.

The trea t men t of evere shock can only be succes ful if w e hav e all the diagnostic facil it ies necessary to measu re what sorts or remedy are nece sary as the process of shock unfolds. This is why the early tran fer to a fully equipped unit housing all the apparatus neces ary for testing and ampling the blood during the correction of Primary Shock and it possible progression Into Secondary Shock , is mandatory

The treatment of Second a ry Shock well outside the sphere of the first-aider but the urgent correction of Primary Shock which, if not achieved, will result in Secondary Shock, can only be effected if the patient i transported urgently to medical care and a fully equipped resuscitation unit, while at the ame time he is protected from all those factors which can aggravate the state of shock during the process of transport. Whenever you have a shocked patient, make a diagnosis, start recording the pulse, but complete all arrangements neces ary for transport as quickly as pos Ible. De lay while trying to sort out detail can be very dangerous.

One of the mo t difficult things for the first-aider to acquire is experience In recognising shocked patients. Once seen the situation is unlikely to be forgotten and it is here that it would be valuable for hospitals to allow selected first-aiders into their accident receiving rooms.

Gibraltar's new HQ

IT

FOR TIl E Fl RST TI Me since it was established in 1883, the Gibraltar SJA Association now h as it s own headquarters Dunng the last 90 years It has met in a variety of different loan ed buildings, a state of affairs which has not only proved impr acticab le but on one occasion downright dangerou s the building had to be evacuated because the ceiling cave d in!

So the St. John Council decided a few years ago to build a HQ of its own. But it faced many problems: lack of money at a tim e when the territory's 14,000 inhabitants were pl;,agued with economic pressures; the difficulty in finding a site on the already over-developed Rock ; and the designing and constructing of such a building when Gibraltar 's building trades were seriously di rupted.

After nearly 10 years' of setback and frustration, the Councils's plans were rejuvenated last October when Rear-Admiral R S. Wellby , then SJA Deputy Commlssioner-in-Chief, visited Gibraltar. After consultation with llE the Governor, dmiral of the Fleet Sir Varyl Begg, Jnd the Council's chairma n, Mr. Charles Gaggero, demolition work tarted on a World War 2 concrete pillbox, which was to be the site for the new HQ 1 I months and 4,000 voluntary man-hours later , the HQ was completed; a nd only by members workJl1g on the ite were available funds stretched t o cover the cost.

Situated on Mantagu Bastion , part of the old defen ces of the Rock, the HQ include a spacious lecture room, store room, offices and a hall; there is also a garden and a large patio for outdoor training

S!. John House, a the HQ is named, was opened on September 6 by the then Governor, Admiral of the Fleet Sir Varyl Begg, which was his last public duty before leaving Gibraltar for another appoin t men t.

This is the fir t St. John building to be erected in Gibraltar , where the Order once held considerable property, for exactly 350 years. For strangely enough, in I 623, another famous admiral officially opened a St. John building on the Rock

From the Electricity Couneil's A mblliallce Bulletin}

St John House with the ancient Moorish Castle in the background, is built on one of the old bastions fortlf ling the Rock

The SJ Council chairman, Mr Charles Gaggero, addreSSing the guests at the opening ceremony; they included the chief Minister, the Mayor, the Bishop Elect, the Chief Justice and the Flag Officer

AMBULANCE ATTENDANTS

by M.V. Moring

He should treat his patients ashe would like to be treated

AFTER THE ARTICLE Ambulance

Driving ( R eview O ct & ov '73), now for some hints for amb ul ance attendants. The higher standard of training being given to professional ambulance aiders at regional training sc h oo ls throughout the country d e mand s that the Brigade, if it intends to co ntinu e to provide a m b ul a n ce transport, must u p -gr a d e the standards of its own crews an d so ensure eff icient liaison when relieving the full-time services.

Qualities

The a mbul ance attendant is a member of a team caring for a patient Often he is the link-man between the 'incide nt' and the patient receivll1g m edical treatment.

He ca n do much t o assist the patient's recovery. H e is part fIrst-aider, part nurse and, in some Instances, part doctor. He needs to have a basic knowledge of nur sing besides being a proficient firstaider.

Hi s first loyalty is always to the patien t. He will, on occasions, receive instructions from a doctor or a nurse which must be carried out a fu ll y as possible (and practical). H e has to respect the patient's re la tives, and advise or comfort them when time al lows, yet be firm witll the interfering but wellmeaning relatIve who can do so much to jeopardise some patIents. La t1y, he needs th e t rust of his crew-mate the driver, who will follow h is instructIons. H IS aim must be to ge t his patIents to their dest ination in a better condItion than when he was ca ll ed in; and do nothing, or allow anything to be done, that will be detrimental to the patIent's recovery

As WIth ambu ance drivers, the attendant be clean and tidy in appearance, specia l attention beIng paid to the hair, t eeth and nails Wh i:ltever th e c ri sis he mu st remain cal m and t ry t o instIl a n air o f tranquillity in those about h im, who may panIc due to the trauma of th e 'incident'. othing Impre:,ses li ke ca lm , decisive actions.

A 11 werill g call Brigade ambulances drl' USUJlly called t 0 t s by me m lw rs of the public

They may also be required to undertake a domICIliary removal or invalid case, \\ here procedures c1lffer accordIng (0 the circu Il1st a nces.

When tra nsfers have to be mack at restricted areas, e.g airports, crews should be famIliar '" ith procedures in force there or enquIre hefore entering the area. Remember th3t It IS .IS import3nt (0 obey road signs and m,lrlungs on priv:Jte premises as it IS on public roads.

On clrrival at an 'Incldenl' nOle the time. The attendant first makes a r3pid assessment of the sltuallon the numoel of patIents, their loc a tIons, the extent of injuries, the presence of further etc

At road tr,lffic ,Iclidents (RTAsl the minImulll of tn?3lment should he carried out before loading Into the vehIcle. Assess the nUl1lber and types ot patIent before loadIng stretchers ""Ith shocked but otherWIse uninjured patIents : otherwise there may be no stretcher available for a more serIous case Load in order of prIority Try to have o.;ollleone in the vehIcle to heep an eye on patIents already loaded whIle others are be Ing dealt WIth I f necesary call a second ambulance . But someone In charge on the scene.

Account lor all persons Involved In an incident. Orten patIents taken aw"y from the cene and laler found, a, the ambulance IS "boul 10 leave, in someone's house Beware of the shocked person who has been given a cup 01 te,,: this u'iually causes sickness whIle beIng transported Patienh being treated in pub li c should not be unnecessarily exposed to either lhe elements or onlookers Keep crowds back But if yOLi need thell hL'lp, lise them.

House IncludIng removals

1'10111 hospit"ls and flrsl JIll posts, demand sllghLly dIfferent tactIcs . On lhe

attendant should announce who he Jnd who he has come for, and then state where he is takIng the patient, JLlst in case there ha'i heen an error. ext a k to see the patient and while bemg shown to hIm note all obstacles which could make the removal ell I fieLlIt. <;Llch as mat:" chaIrs, tairs, doors etc. It is imperatrve that you first go to see the patient do not allow rela tives to rush you or try to save you r leg When you do meet the potient greet him cheerfully. Introduce yourself, soy why you are there, and what you want him to do (ie: nothing). His response wtll be an indication of hIS consciousness. It may he necessary at this stage, before carrying out preparations for removal, to adjust the patient's position to improve his condition : the chrol1lc cardIac failure may need to be propped up with pillows to assist hreathing; the unconscious patien t should he placed in the recovery positIon, unles he is being constan tly supervised as in a hospital ward.

On the way back to the ambulance obtom detail from relatives etc, JS to the extent of the condition: How long has he been ill? Has he bed sores? Is he incontinen t? Iso speak to someone a bout removing anything previously noted which may hamper t h e removal of t h e patient (and rerltlc them before leaving the premIses). But check that there is no a l ternative exit before disorganislng home. With a removal from a house , check that the

The carry sheet and harness, but don't expect such Ideal stairs or patient - when It comes to the real thing

patient', doctor ha declared him fit for removal or otherwise sanctioned the journey I moy be necesary to personally check with the doctor on this point, e pecially if the patient's condItion eems to be deteriorating.

On arrival back Jt the ambulance, tell your driver how you wi h to remove the patient, or ask his views if you are undecided. Tell hIm brief!} of the patient's condition and any factors to be borne in mind. The many ways of removing a patient from premises vary according to the patient's condition, the obstacles and the equipment available. It is always beLLer to load stroight onto the tretcher or trolley, if this is how the patient L to travel. The patient is then only moved once, and can be made comfortable in pnvacy. But this is not always pOSSIble, and other mean such a a carry-ch:llr, carrying sheet, poles and canvas, or wheelchair may have to be used

Before removing the patient from the premises, check that he has all hi belongings and any noles or letter from hi ' doctor Opinions vary as to whether to take any of the patient's medicine or tablet to hospital. It i best to take all prescribed medicines and hand them to a responsib le person at the de tin ation. On no accoLInt shou ld the patient be a ll owed to take them. For it has been known for patient to dose themselves with these o ld medicine , while other have been

Aga n, in practice loading can be st r aight forward But the more one practises such stretcher work, the easier it is on a wet and windy night

prescribed 111 hospital which have an opposite effect. Details of last doses of each medicine should also be noted.

During removal the patient shou ld be adequately covered with blankets, and slippers or bed-socks worn. Use any safety straps provided on the apparatus. Patient often need reassurance while being carried downstairs, and beware they do not grab a bannister rail en route, as this can result in ana ty fall for everyone. Use a plastic or rubber sheet for patients likely to be incontinent: and s u perating ore should be lightly dressed. When the patien t has been loaded, secure the stretcher safety catche He should be positioned so that he i comfortable, safe, and to promote rather than retard his recovery.

Before tarting on the journey en ure that the premises, if a private house to be left unattended, are secure and that accompanying relatives have return transport and key to the hou e. An anxious wife often leaves her purse and keys locked in the house. A second check hould al 0 be made that all the patient's belongings, medIcines, letters, note, etc, are in the ambulance. Finally, the attendant gives brief instruction to the driver regarding the urgency of the journey. The e may need to be amended during the journey.

Th e JOLIrney

En route the attendant's job i only just beginning. H e may need to examine

AMBULANCE

ATTENDANT (contd.)

accident victims for less obvious injuries. Careful checks hould be made on pulse, res p ira tor y rat e and 1eve Is 0 f co nsciousn ess, Any changes sho uld all be recorded. Tension of bandage, splints and dres sings sho uld be checked and amended if necessary. Never remove loose bandages always app ly a second. Make notes of patients' names, addresses, dates of birth , previous history, relatives to be informed, time of last meal, etc; a patient may lapse into unconsciou ness before arrival at hospital. Talk encouragingly to patients but do not provoke arguments. Advise against discussion of the cause of accidents, as you could be called as a prosecution witness in court. First-aiders do not enjoy the same immunity as doctors.

The invalid patient will require attention of a different kind.

R e-positioning on a long journey, oxygen administration sips of water (if allowed), bedpan or urine bottle even the delivery of a baby. It is best to request the driver to stop for the application of these latter proced ures.

Beware and be prepared for a patient to vomit by having at hand a suitable receptacle. A tissue placed in the bottom of a bowl helps to eliminate splashes, and makes cleaning the bowl easier. The patient must be stea.died during vomiting and plenty of tissues should be at hand for him to wipe his mouth. A mouth-wash is refreshing after suc h vomiting but further drinking s hould be discouraged as this produces a recurrence. Vomiting lowers the body fluids, thus the blood pressure, and so in creases shoc k. It must be avoided if possible. The patient's condition should not be di scusse d other than in reassuring him and hi s relatives.

Arrival

Ha ving arrived at the destination (the time being noted), the ambulance driver should announce the patient's arr ival and view the arrangements for rec eption. The driver should now follow similar procedures to those of the attendant when collecting the patient. The attendant may need to brief the driver concerning the patient's condition, prior to giving a full report to the doctor or nurse after unloading h e patient. The documen ts ca n be tak e n in by the driver so that refere n ce to them can be made. Only in very rare instances should the attendant leave the patient in the care of the driver (who would know little of what to expect from the patient). After unloading the patient, his be l ongings, and handing over the medicines and report on the patient relatives should be escorted to the waiting room or office. The vehicle must then be tidied In readines s for the next case. Di rty pillow cases or blanket s 16

shou ld be discarded replaced (sp:ues shou ld be carr ied). R eceptacles must be washed and dried. Wat er containers washed and recharged If n ecessary the floor should be mopped and any litter disposed of. An air freshener spray lightly applied clears the air. When an infectIOus case (or even suspected) has been conveyed, more vigorous cleaning and disinfection must be carried out. (Your loca l a mbulan ce officer would, I am sure, advise further on thiS pomt)

General

Wh e n uSing an ambulance for transporting h andicapped people they c;hould be given the same efficient

BOOKS

THE OUTLINE WAY TO SLIM

by Or. Christine Pi ckard. Pr oduced for the Outline Slimming Bureau by Queen Anne Press, London Price 35p

Being overweight IS dangerous to health. Coronary artery disease, bronchitis rheumatic conditions and many othe r diseases are made worse by being overweight.

At best being overwe ight is like carrYlng a heavy s uit case around with you filled with things you don't want. At worst it will cause death severa l years earlier than it need occur.

Anything which help to keep weight within acceptable limits is welcome. This slim book is easy to read There are weight tables for people with small, medium and large frames. These offer a target.

There are tables of calories availab le in the foods commonly eaten. A list of carbohydrate calories would have been useful for the writer quite rightly advocates cutting down the total number of calories, but especially the carbohydrate ca ories in starchy food, cakes, biscuits, sugar, etc.

The writer condemns 'fad-diets'. Any success they may have is due to what lS not eaten rather than the diet itself. Some fad-diets are deficient in essentials such as vitamin. It is better to cut down one'. intake, especially of carbohydrates.

Condemnation of drug treatments is in accord with modern

VISUAL AIDS

thinking. Drug s used to suppress appetite are only temporarily effective, Many of them cause wakefulness and drug addiction is not uncommon.

Th e sensib l e advice about eating habits, drinking habits, and exercise (little and often) is well worth taking. A section on recipes makes it easier to produce tasty non-fattening meals. There are many readers of the St. John R eview whose lives would be lengthened and whose health would be preserved by investing 35p. in this book, and following the advice given

C. O. Hug hes

AN INTRODUCTION TO HUMAN PHYSIOLOGY by

David F. Horrobin

Medical & Technical Publishing Co., Ltd. Paperback £2.2 0p , Hardback £4.50p.

An excellent book but not for the average first-aider, because it is written for medical students and other medical personnel who need to know physiology

It could be in teresting and worth while for medical auxiliaries who can read and understand a simplified, well written book. It will be particularly useful to those of us doctors and nurses who studied physiology some time ago. It will bring us up to date without a great mental struggle. It easy tyle and the author's assumption that the reader has little knowledge of the subject makes reading not too difficult. There are easily understood line diagrams.

C. O. Hu ghes

TIn SI John / llIl hlllance ,1!1I 11t·I!cUIa , lppraisal Pall 1'1, II'llidl II1cets jurtlllglttll' at IIQ alld cumprtses dU('lOrs, IIl1rSes. /irst'OIden alld "lslia lOld experts, IS OIiC 0/ lite ojjic ially appall/ted panels uI 111 (' Brilisll ,lleulcal 1ssociallOn. liS rcrl£'II'S hcillg fJlIbhslted III Iltc BJ[A 1IIJormallOII III 197:!, lite VII/de (u FillI1s alld Fir s I,u I\ 'as fllIbltsltcd JrOI/1 tlte Stores, J5p pllls poslag e). In lIlid 1974 If is IlOped 10 fJlIhltsh, wilh Ill c kil/d assistance 0/ r/t e Briris/t f.lfe ,·I SSIl/'aIl(,(, Trusl a compre/I('I/\'/I'£, /lllIlli'1I1cdm gil id e

handlJl1g as a serioLlsly ill patient. R emember that they are suffering from an illness or IncapJclty, and very often have psycho logICal problems as well.

Finally, all Involved with Brigade ambulance,> take every opportunity to learn more about ambulance work, equipment, and its uses and availability Constant practice in the use of ambulances and equipment is very necessary, especia ll y as some vehicles are o nly rare ly ca lled out.

The ambulance attendant shou ld always remember that one day he may be the patient So he shou ld treat hi patients as he would like to be treated,

TIME ON YOUR HANDS (30 mins,) Hire : £3

Oi tributed by : Concord Film, Nacton Ip swich, Suffolk

This film 100J...s at the problem of retirement through the eyes of a G. P It shows the secret of keeping busy and acquiring alternative skills.

The panel considered the ubject of importance but felt that this film is a dull presentation that fails to reach its laudable objective. The film uffers from a poor introduction by a member of the medical profes ion and the fact that the examples of retired people hown in the film are those likely to be fully occupied with their hobbies, etc. The film would be more useful were it to give pr.lctical adVIce to those about to prepare for retirement to an emp ty life. It i also too long

Audience: Those approaching retirement. Social workers, etc.

VISUAL AIDS(1966) (Colour: 27 mins.) Hire

Di tributed by: Guild Sound and Vi ion Ltd., 85 Oundle Rd Peterboro ugh ,

Sponsor: Mini try of Defence

Th e use of vi Llal aids s uch a cha lk boards flannel boards projector, etc, in teaching. Intended for traini'ng Royal avai instructors.

The panel co nsidered this prize-winning film to be an excellent example of filmcraft; it is n ot only co mpletely professional but a lso e nt ertaining. It puts across its visual aids message with clarity and co nV iction.

Audience: Should be screened at regular intervals to all St. John instructors

ONE MOMENT PLEASE (1970) (Col 12mins.) Free

Distributed by: Briti h Oxygen Company

The theme of this accident prevention film is that most accidents are unnecessary; that they are caused more often by responsible people indulging in a moment of care lessn ess than by fools acting foolishly.

The panel considered this film commendably uccinct - the accident situations portrayed :lre everyday and the film is reasonably convincing.

Audience: A useful 'filler' for any programme but of specific value to indu trial audiences concerned with factory safety.

PREPARING AND GIVING INSTRUCTION {20 mins,} Hire : £10

Distributed by : T. F. I. 14, St. Mary's Street, Whitchurch, S hro psh ire.

This film covers the basic learning principle of interest, attention and memory and show how the enses are involved in the learning process. It considers incentives, lesson plans and how to avoid common instru 'tional errors.

The panel wa imp res ed with this film. Although directed at the Building 1ndu try it in truction in preparing and giving les on i valid to all di sciplines, The film is b oth omprehen ive and conci e and covers its subject in a very i nter esting manner. aturally, this production cannot be used in olation but as a ummary or aid to conventional instru tion it will have great value

Audience : All engaged in instruction, In St. John will pecifically be of value on lay instruction cour e and leadership training.

, Area Superintendent. 1

o u s dr ivi n g. S lo ugh B. F Rockell

COMPETITIONS

f r om J E. Smith Area Staff Officer

Dur i ng h e open for um of a rece n S t. J ohn national conference it w as aske d wh et h er so m e th ing co u l d be done to get ove r the a pp a rent unfa irn ess i n co m pe t itions of vo lu n tary first-aiders h a v i n g t o co m pe t e agains t 'profes ional' fro m the national se rvi ces, ie po l ice, f ire service, Coa B oard, etc.

H was sai d t h at t h ese people have the a d vantage of training

w hi l e a t wo r k (an d being paid for it). Almost before the q u e st io n e r ha d finis h ed speaking a m e m ber of a so ca ll ed pr o f ess o n a l t ea m d enie d t hat they had m u ch advantage, and sa id th ey did n ot get p a id for tea m prac t ice; a so so m e members

o f t h ese se rv ices ha d to make their own arrange m ents to take first aid cer ti fica t es.

O ve r th e yea r s m any of u s have co n t r ibuted to t his idea that co mp e titi o n a r e ofte n u nfai r , but perhaps we are wrong. Co mp etit on work gene r ally would be helped if, through the R e view, t h e facts on this issue cou ld be s u pp l ied by readers.

Surr ey J };. Smith MISSING CASUALTIES

fro m J G Evan s A f t e r a r ece n t ma or d isaste r night exercise he point that cas u a lti es ha d been 'missed' was raised, and t h e m ain r eason for thi s, it wa s dec id ed, was t h at when ca r rying first a id packs and /o r st r e c h e rs i t is diff icult o a lso ca rr y hand-lamps powe r ful eno u gh t o searc h for cas u a ties. S ince, [ have come up with the idea of T a fIi g ht' , or ca ll i t what yo u wil l T afl ight is a p last c co n taine r about 3 inches long, about .'Y.! in ch in di a m ete r as ill us rated. ,,- RED TRANSPARENT COVE R , , F L A

READERS VIEWS

The New English Bib le concludes the story as follows: 'Ge h azi wen t on ahead of them and IClid the staff on the boy's face, but t h ere was n o sound and no sign of life. So he wen t back to mel!l elisha and told him that the boy had not roused When E l isha entered the house, there was the boy dead, on the bed where he had been laid. H e went into the room, shut the door on the two of them and prayed to the Lord. Then, getting on to the bed, he lay upon the child, put his mouth to the child's mouth his eyes to his eyes and his hands to his hands; and, as he pressed upon him, the chi ld's body grew warm E lisha got u p and walked once up and dow n the roo m ; then, get t ing onto the bed again he pressed upon hi m and breathed into him seven t i mes: and the boy opened his eyes.' (v.3 1-35).

I don't know how the writer obtained all the details of E lisha's treatment for no one witnessed it. If the account is accurate, it appears that Elisha first prayed to God; then covered the child's body with his own and pressed upon it, thus warming it; then he walked up and down the room; applied bodily pressure to the child again; and finally breathed in to his lungs This revived the child.

(4) H e was ab l e to provide water for the armies of Israel J udah an d Edam, when they were stranded without water' in the Wilderness of Edom in the campaign against the Moabltes (2 Kings, Ch. m , v. 1-20).

(5) A prophet died in debt. A creditor took his two sons to be slaves. Elisha increased the small quantity of oil in the widow's flask to such an extent that she was able to raise enough money by selling oil to redeem her sons from slavery. (2 Kings, Ch. I V, v.I-7).

This being a, I venture to suggest that Elisha's restoration to healthy life of a small boy who had been dead for about twenty-four hours could have been achieved only by what Dr. P ayne calls 'the exercise of s upernatural powers rather than by the application of techniques readily available to all'. In other words, this was another of Elisha's miracles.

British Columbia B K. Wallace

CA DET UNI FORM

from D a vid Tr e an o r , Cad e t L e ad e r

O ctober, Review , Around and About showed the 'old' and the 'new' ambulance cadet uniform.

of the penlight battery cell, so lighting the make-and-break type bulb So by simrly removing a pin we have a rJasllJng light.

These TafIights CJn be threaded onto a belt through the nng of the removable plastic pin.

So anyone going early into a di sas ter area at night should wear a belt of Taflights, and carry a powerful lamp As he finds casualties he pulls a Tatlight from his belt a nd attac\lC' it to the casually's c l othing by the metal trip safety pin.

F irst-aiders will then instantly 1.'1.' where casualtIes are.

Slough J. G. 1::1'(1115

A M I RACLE O R from Ba s il K W a ll ace

I enjoyed Profes 'o r J P. P ayne's erudIte artIcle on resu citation In the J une and July R eview. But there's one thing in his introduction that bothers me. Pay ne appears to consider that elisha revived the dead Shunammite boy by the application of accerted medical technIques. nd he IS not Jlone

D u ring my twenty-t wo years as a first-alder In Canada I have heard several medical men refer to the Jccount of l:.ltsha's revival of the child given In :2 Kings, eh. I V, v.34, as the first recorded instance of oral resuscitatIOn. But was It?

Let us look at the tory 111 detail. I quote from the New Eng l ish Bib le, 2 Kings, Chapter I V

When the child was old enough, he went out one day t o the reapers where his father "vas. All of a sudden he cried out to his father, "0 my head, my head!" His father told a servant o carry him to his mother. ll e brought hIm to hiS m o ther: the boy sat all her lap till midday, ;'lI1d then he died' (v .18-20) (To me that sounds like heatstroke rath e r than asphyXIa).

Then what happened') H is mother laid the chtld's body on the bed in Elisha's special upstairs room , and hUrri e d orr on a donkey escorted by a servant on foot to find on Mount Carmel (v.21-25).

I f my m ap-reading is correct, the distance fro m Shunern to Mount Carmel is about 26 miles as the crow f1iL's. Allowll1g for a few extra miles by the ground route I est imat e that the mother C1nd servant took at least 7 hours to reach Mou nt Carmel.

They apparently arnved at Elisha 's dwdllng before nightfall because he saw them coming (v.25). I doubt whether they would have made the return Journey once dad,ness had fallen. I n an y case Elisha didn't leave Mount Carmel Immediately he receIved the n ews . H e sent his servant Gehazi ahead with the prophet 's stafr, te ll ing him to hurry to Shuncm and Jay It on the de:Jd child's face This dIdn't satisfy the moth e r, so she and E:ltshll fo l lowed later (v .29-3 0). All things considered, the clllid mu s t have been dead for a whole day by the time coml11L'nced resuscitation.

As a lay instructor I fail to understand how Elisha's treatment can be described as the first example of the mouth-to-mouth m e thod in history Surely it is impossible for a grown man to inflate a small child's lungs effectively while lying on, and pressing on, the child's chest? Also even if Elisha's technique had been perfect by modern standards, could he have revived a body that had been dead for a day except by a miracle?

It must be remembered that after Elijah wa taken away in a whirlwind Elisha came mto possession of Elijah's cloak and at the ame time received from God the power to work miracles. By the time the Shunammite lady came to him for help he had performed at lea five notable ones. They were:

(I) The day that Elijah was taken away Eli ha used Elijah's clOak to dIvide the water of the Jordan and rejoin the prophets from Jericho on the other side (2 Kings Ch. II v.14)

(2) By thrOWing salt from a new bowl into the spring that con tituted Jericho' s water supply, he purified it and put an end to the epidemic of miSCarriages suffered by women who drank spring water (2 Kings, Ch. lI , v.19-22)

(3) H e caused two she-bears to maul forty-two children who Jeered at him on the road from Jericho to Bethel (2 Kings Ch.l v.23-2S). ( P retty brutal punishment for a group of cheeky urchin !).

I think the belt worn over the jacket on the new style looks untidy and would be better worn on the trousers as in the old style. Also cadets do not use much of the first aid kit carried in the haversack , which also looks untidy with the new style. Why shouldn't cadets carry a small first aid kit in the jacket pocket (as adults carry) and not carry a haversack?

Bridgewater

M O R E TO LEARN

from

David Treanor

We were all eager to start practical first aid, so we were a little despondent when we learned that our evening was to be spent learning artificial respiration. We knew all about that. Or so we though t.

[nstead of conveniently lying on a table, or on the floor, our Sussie-Annie was in a tangled heap of imaginary debris. We had to crawl through upturned chairs and under a table until we found our victim , and then we started to give her breath; but, lying in awkward po itions , we very soon tired, so the next first-aider had to come through another tunnel to take over. But when he got there he hadn't the faintest idea what to do By the end of the evening we had found out that there is a lot more to learn about artificial respiration than just head back pinch nostrils and puff!

Wantage

A. Ball

ANY OLD

NEWS from SCOTLAND

More baronie of the Order in Medieval S cotland S tanhope: The Stanhope burn in Peebleshire runs into the Tweed about four miles south of Drumelzier. The barony belonged to the Order of St. John and is mentioned in the famous charter of Mary Queen of Scots which transferred the Order's lands to Lord Torphichen. But very few entries in the Chartulary of Torphichen refer to it. In the reign of Charles I it was acquired by Sir David Murray whose son be ca me a baronet, although since then the family seems to have died out.

T h anke r ton: This barony in Lanark shire was also referred to in Queen Mary's charter, but again there are very few entries about it in the Chartulary of Torphichen. The ruined walls of St. John's Kirk are st ill to be seen just sou th of the road to Symington and Biggar a little after it branches off from the main road from Lanark to Carlisle. This church of St. John , or the chapel of St. Ninian close by, may have been founded by thc Knights of St. John, but its earliest name was Wood Kirk (or Wade Kirk), for it was situated near a large wood , and it appears to have belonged to the monks of Kelso.

G a lt w ay: The b aro ny of Galtway or Galtua was also mentioned in Queen Mary 's charter, although again there are

few other .reco rds of it. The si te of Galtway church is on high ground abo ut two miles from Kirkcudbright , to the east of Mutehill , about half a mil e east of Low Banks; the ite of Gallway village lies beside an old quarry about a quarter of a mil e further east. Both s it es l ie north of the A 7 J I road leading to Dundrennan

The ancient parish of Galtway forms the middle part of the pari h of Kirk cu dbright. In 1586 Robert Linton was given a pension of £10 out of the lands of Gallway for services done and to be done by him 'as Bailie of the Regality and as Pursuer in a ll actions before the Lords of Council, Sh eriff and Commissars of Edinburgh and other inferior judges.' Apart from Torphichen, this completes my occa ional notes on the eight baronies m en tioned in Queen Mary's charter. Records arc so scanty that it would not have been possible to write them without the help of Maj or W D. Cargill Thompson , the senior knight of the Order resident in Scotland; he is so senior that his knighthood was conferred before the foundation of the Pri ory of S co tland in 1 947. Major Cargill Thomp so n' s Bibliognlphy of the Military Orders in Scotland c.1850-1950 was published in the Annales de l'Ordre Souve rain Militaire de Malle (December 1962) and is a mine of information.

Although there is n o satisfactory book On tl:c Order in this bibliography gIves det a Il s ot the many references to brothers of St. John in the proceedings of vari ou S cottish learned SOCieties. I is La be hoped that the Univer ity or Sl. Andr e ws will publish the writings of the I ate Dr. Angu Ma cdona ld , whose unpubl ished essay o n the Ord er in Scotland is one of the most comprehensive of the it e m s li ste d by Major Cargill Thompson.

J . H CalcIer Mac Leod

St i rl i ng

Since it s fo rmal inception in 197 2 remarkabl e progress has been made by the Stirlingshire Bran ch of the A ssocia tion. Th e member hip now numbers 174 and severa l most s uccessfu functions have been held during the past year in D en n y, Kippen , Falkirk an d at Drumbowi e.

Two projects have been adopted, the provisio n or a hospital bus for handi capped persons in 1972 and the provision of a foeta heart monitor machine in 1973 , both to be used ilS directed by the Boa rd of Management of the Stirling Falkirk and Alloa H ospita s. The bu was handed over in December 1972 .lnd the heart machine in July 1973. Under the aclive and able chairmanship of Dr. Ma cfar l ane Gray, ilnd ab ly as isted by Mr. A. Ru sse ll as secretary and Mr. G. L. Winni ck as treasurer, th e Stirlingshire Branch has contrib uted much In a short space of time and has set an examp le to the Order as a whole on how to achieve it s aims with speed and effic ien cy.

WALES

Visit Wales Bo n n

The first stage of an exchange visit between SJA Wales and Johanniter-Unfall-Hilfe in Bonn t ook pl ace last August when a mixed party of Welsh members (aged 18 to 30), led by Chief Training Officer for Wales Peter H arr ies, visited Germany for 8 days. They travelled by coach (which stayed with them for the week) via Dover, Calais, over-night at Bruges , Aachen and arrived at Bonn 36 hours after leaving Cardiff.

As well as being shown the structure and workings of the Brigade in Bonn and other nearby cities, which included covering a public duty at a sports stadium with their German hosts, the Welsh members vis ited hospitals, fire brigade 20

On October 4 Mr. E. S. Ojeriakhi, Assistant to the Medi ca l Offi cer of the Nigerian State Railway s, viSited Wrexham Dlvi ion (above, with officers) to see how a mobile first aid unit is used affcctively.

W rexham DiVision staged a 'mini' major accident , u s ing the unit, in which it was assumed that a gas main had exploded at a Girl Guide HQ while a meeting wa s in progress.

The unit. uncler D O J. Pri ce, was on the scene 4 minutes after the call came through The 25 Guid es in the exercise acte d so realistically that soo n a c rowd had gathered outside th e HQ thinking some thing was really amiss. But the unit team soon had everything sorted out and within an hour every casu'aity wa s labelled and indexed. J .R-S

headquarters, the palace of thc Federal Pr esident of Germany the German Parliament Building, and many places of general interest including beer-houses of course.

After supper on the final eve ning together, the WeI. h members entertained their hosts to Welsh songs and music, the girls having brought their traditional costumes with them for the well-rehearsed Welsh evening. The party closed with everyone signing first a Welsh song, then [) song in German

On the return journey to Wale s, during which they stayed the night at O stcnd, the main subject of cover ation a mong the party was how SJA Wales shou ld plan such a comprehensive and enjoya ble week for their JUH friends in 1974.

Trainin g

Th e theme for this year" .Wales training course, held at L1andudn o, wa First AId i n Di saster with a simulated disa ter

OVERSEAS

Training at L1andudno. (Above) Dr J Noel Roberts makes a pOint to Commander D. S Stephens, from N reland, an d Mr E Ojerlahki, from Nigeria. (Right) Casualties a rriving at exercise reception cent re ( Photo Terry Taylor. L1andudno)

arrange d on the Saturday. An explosion had occurred in the conference hotel where some 30 casualties were trapped and injured. The men formed themselves into teams while the nursing personnel opened a temporary reception centre nearby. The exercise proved most succe fuI.

1t was watched by the Chief Commissioner for Wal es, Lt. CoL J. R. L. Traherne , along with the Commandery Commis ioner D. S. Stephens, who was a guest of the Pri ory for Wales at the conference. and Mr. E. S . Ojeriahki, a Ddri ct Staff Officer from igeria.

Altogether 170 delegates , many of them young people, attended the conference. an ll1crease on previous years.

On the Sunday Mr. Stephens spoke on St. John in action in Northern Ireland a most inspiring talk Dr. Buddig

Senior Consultant Anaesthetist, Clwyd & Dee side Ho spital Management Committee, spoke on R esuscitation and the effects of smoke on Casualties' while Mr. Howes, Acting Chief Fire Offi cer, Caernarvonshire, addressed the conference on 'The H azards of Fire.'

Cadet NCO Course

About 100 ambulance and nursing cadets attended the 13th South Wales cadet NCO course at St. Athan, October 27- 28, which was opened by the Assist. Chief Commi sioner Lt. Col. E. R. anney-Wynn with a talk on leadership within SJA.

The course, organi ed by the Chief Training Offi cer, who was a sisted by senior cadet officers , included map reading, which was followed by a 6-mile circular walk using maps and compass.

NEW Z EALAND

Meet

News from Divisions/Centres

III/ORCS -Area Superintendent Mrs. be Unett, promoted during November to tile Grade of Officer of the Order was appointed !\r ca Superintendent in 1970 when she join ed the Sl. John Ambulan ce after many yea r of \\ork with the Association It in recognition of her service to tile Association that ,he \\'a, admitted to tile Order a\ a Serving Sister in 1966.

Two new Serving 8rothers arc t-Ir. T. W. Bainbridge, ror Illan) year\ secretary of the Stourbridge Centre, und C. Wileeley, member or the Asso ciat ion and 13ngade for 33 years.

YORKS -On a glorious sUllllller-like October 6, in the middle of Grassinglon moor in the Yorkshire Dales ational Park ambulance and nursing cadets of West Rllill1g ( ortilern Area) held their annual outuoor c\crcise.

Two members of the Wharfedale !-ell Re scue Club, along \\ ith Area Officer, Stuart .\1cVeigil and Jim IcManus, arranged a of incidents along the side and In the bottom of a dry gulley.

Patient \\cre treated for exposure, exhaustion and varIOUS fruclures. All thcse incidents required the u,e or carrYlIlg sheets, and man-lifting arrangcments. iany methods of carrying the patient were used which are not described In the first aid manuals, but have bCl'n \ucce,,!'ull} tfled dunng tile many rescue, carried out by this club.

This proved a vcr) practical exercise, tho

Iy enJoyed b) tile cadet,

O BIT UARY

CL'RALJ) GUISI ', Sergeant, I3romsgrove Alllbul<lIKe WorceQersi1irc, JOlll ed Brigade in 1932 Serving Brother. ARTlIUR K OTT, 7 4 member of the St. John COlillcil,

Chesterfield Corps were InsJ-lected recently by

rough

the new Derwent Derbyshire, Major B. Sheffield Newspapers) Area Commissioner, A Meadows (Photo:

Exmouth Ambulance Cadet first aid team

(Photo: Edward Lucas, Exmouth)

REVIEW CROSSWORD No. 12 (73) Compiled byW A P otte r

ACROSS:

I S y m p t om of patient wh o s ees more th an h e sh ou ld (8) 5

Pre p are d h e ski n for surgery. (6) 10 Fa c ia l f eat u re of anim a l for w ild flower. (7) II Mad l ia r reformed a ava l offi ce r. (7) 12

Und eci d e d type of fra c tur e (4). 13. ot an e l aborat e variety of m usc l e f i bres (5) 14. Think abo u t future act ions with a l ett e r fr o m 13 across. (4). 17. Chronic infe c tiou s d isease aff ec ting

m ai nl y lun gs, bo n es a nd gl an d s. ( 12). 20 R eaction of tis su es to t ra um a o r i nfe c tion (12). 2 5 S harp, f ractur e d kn ee (4). 26. R emai n i n g after amp u tatio n (5). 27 Prepara t ions inje c ted to co n fer pass ive im mun ity to infect o u s dis e ases (4). 30 Dru g co n str ict in g th e pupil in treatment of gla u coma (7). 31 Light, ie ve -l ike bo n e of the sku ll. (7) 32. It o bvious th e patient h as one removed f r o m t he c entr e. (6) 33 A s trik e for int es tinal obst ru ction ( 8 ).

DOWN:

I. Gives th e fir st aid ec turc s o f th e h ig h es t d e gr e e. ( 6) 2. F o rm of drug provided by ca ptive with red ba c k (6) 3 Amor o u s gl a n ce is n o th i n g with broken leg. (4). 4. Condu c ted a lo ng a n e rve fibr e in respo n se to a s timu lu s. (7) 6 Nursing s e rv ice pr o vid e d by th e loca l authority (4) 7 Masc u lin e tr a it s e xhibited by a fe m a le (8 ) 8. L ack of resonanc e found o n p e r c us s ion ov e r s o lidifi e d lung tiss u e (8) 9 Ma n ups e t be fore food for a m e ntally-derang e d pa t ient (6). 15 P regnan c y like y to produ c e a s urgi c al e m e rge n c y (5). 16 F l uid ti ss ue (5) 18. D o es thi s tonic give th e li ft req ui re d ? (4-2-2). 19 erv e conveying 4 d o wn to th e br a in (8).21. Ma ny tr e at wr o ng l y puru lent exudate. (6) 22 P olitici a n

w it h a poi n t in tria l in vio le n t sto r m. (7). 23 Se c reting m e mbr anes co ul d be as sorc (6) 2 4 S ore of those who h a ve co m e fa r on h o rse or bicyc l e (6). 28. L ega l r ig h t to withhold goo d s fo r t h e sp l e e n (4) 29 Vesse breaking hip s. (4)

SOLUTION TO CROSSWORD No. 11 (73)

ACROSS:

1. V ie ws; 4. I ll-at-eas e; 9 Sth e ni c; 10. Triumph ; I I. C lot ; 1 2. O s t eo; 13 bpic 17.l:.ndure; 18. T empo r a l ; 19. Ai d ; 20. R hombo i d ; 2 1. T a rs u s; 24 Tied; 2 5 Ps oa s; 26 M as s; 29 Tor s ion

BALL PENS BALL PENS

be'S

AO""e

Often an , • eld erly person just doesn 't get enough to eat. Sometimes he's too depressed to face food . Often there's no -one to cook proper meals for him. Or perhaps he can 't afford more than a limited range of convenience foods . And the result: undernourishment.Without proper food he can't be bothered to get things done. He can't sleep properly at night. He feels I despondent and low. And before he knows it he's in the Downward Spiral.You can help by recommending Complan. Compl'an is a milkfb d balanced food that's just right fbr an elderly personit's easy to make, tasty and very gentle digestions. It contains all the vitamins , proteins and minerals to give him the nourishmerit lie needs . Complan is good-value too-one takes the place of